P112768 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
To,. of Bedrooms Date
This permit is granted to for the installation of a septic tank-
4
at the residence of y„w: (!C� _ Address 64,1���1=�.'.
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address J.
l?o. of lines
��width �� in. Total Length —ft. 1\74o. of Sq. Ft %,q
yj,e of filter material «� s."`��iYJ�1L[! , -% Total tons used Q
Minimum Requirements: House TrailerTank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall
or his agent.
Date of final
install a septic tank in Davie County without a permit from the Health Officer
approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.