689 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
o, of Bedrooms 17 Date /D
"his permit is granted to cs� for the installati�o/n of a septic/ tank
at the residence of � _ _ Address_ -FV/ aAusc _
Building Contractor TV11��{ o Address & / o c
Septic Tank Specifications: Length Width Depth Capacity Gal. 9_�w
Manufacturer's Name Address C>4L&ff z� _
No. of lines g width 3 in. Total Length/
ft. Uo. of Sq. Ft. D �
T-Te of filter material���, �'_ Total tons used 3 y
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 L22JO
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent. L,�'7� �/ � xr—
Date of final approval 1 r %15 /fG% Signed: 2
/ Z Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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