P9171 Edwards RdDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms Tho ,/a�,x)4Date S9 /
This permit is grante oto OS Q /7' for the Illati i of a eptic tank
at the residence of C� 121 h g2 Address nst /,
Building Contractor Address
Septic Tank Specifications: Length Width Depth'• Capacity_ Gal. b t)
Manufacturer's Name Address r
No of lines width qO in. Total Length -, ft- No. f Sq. Ft. �p J
Type of filter material Total tons used a o'
Minimum Requirements: House Tra' er Tank Cap. 800 Sq. ft. line 1+00
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: _ 263 tGt. UdA4A "" G).
Septic Tank Contractor
Note: Make sketch of disposal.system on back of sheet and mail to Health Center,
Mocksville.