3532 Hwy 801N (2)DAVIE COUNTY HEALTH DEPIa7liENT
SEPTIC TANIL PM�JT
No. of Dedrooms Date
This permit is granted to � for the installation of
a Septic Tank at the residence of mgS%ddress")
Duild_ing Contractor cp Address
Septic Tank Specifications: LengtY p tlidthAV- Depth Capacity9�KO Gal.
Ilanuf acturer i s Nan. e J Address
No. of lines Width in. Total length.Z r- Ft. No., of Sq.Ft.�11
Type of filter material. _ 1���✓ � Total tons used S1, 00
i,iinimura Peouirerments:
House Trailer
Two•-Dedroom House
Three-; edroa i House
Tank Capacity
8100
800
900
Square Ft, of Line
400
600
900
No one shall install a septic tank in Davie County vrithout a perriL-i.t from the
Health Officer or his agent.
Date of final Approval ( — l y l4 `Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed _ef&.� i� �-, �.-, e "- `
Septic Tank7Contractor
Note: I,Iake sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
i p6t> CI,
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