P52171 Edgewood CircleDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 1 Date
This permit is granted/ to s ,� ,r for the installation 6f/a septic tank
at the residence of _V 9"Z 1 Address sura KIS
Building Contractor L .Address
Septic Tank Specifications: ength Width Depth Capacity Gal. e -D
Manufacturer's Name- dd A.`_p c�, �i �o Address
No of lines_C21 width5-I in. Total Length�t. No. of Sq. Ft. 9'0
Type of filter materialTotal tons used
Minimum Requirements: House Tra�i4r Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
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
specifications.
Signed: Zau�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.