P91765 Hwy 158. -•
DAVIE COUNTY HEALTH DE'PART'MENT
SEPTIC TANK PER1%dT
f
No, of Bedrooms
. )A, Date
This perm��it is granted to L6 ?� Q� for the installation
of a Septic Tank at the residence of-' Address
Building Contractor Address
Septic Tank Specifications: LengthWidth ,S'�Depth__Capacity C�GG� Gal;
I,Ianuf acturer ' s NameQ� y _.��'_ Address
idon of lines L Width-IZLin. Total length /31/ ft, No. of Sq.Pt._ G
Type of filter material Total tons used %V/
Kininnam Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House 800 600
Three -Bedroom House 900 900
IIo one shall install a septic tank in Davie County without a permit from the
Health Officer or his agent.
Date of final approbal
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed
f&. -
'Septic Tank Contractor
Note: 1 -lake sketch of disposal system on back of sheet and mail to the Health
Center in Aiocksville.
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