2030 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms `� Date ?� I d
'.!'his permit is granted to for the installation o a septic tank --
at the residence oflAvk Address
Building Contractor Address Y_
Septic Tank Specifications: Length Width Depth Capacity Gal. 4E_ a
Manufacturer's Names - Address
No, of lines width "in. Total Length cJ.Zs ft, No. of S - Ft. �e73
Type of filter materials .�� _ Total tons used 2 f�
.1-Adnimum Requirements: House T ailer Tank Cap. 800 Sq. ft. line I►00
• Two-bedroom house 800 600
Three-bedroom hou� OO
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval-' — Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to spegificatiens.
Signed:
S tic Tank Contractor
Note: Make sketb'_11: of disposal system on back of sheet and mail to Health Center, Mocksville.