P11469 Hwy 158/S*9
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Uo, of Bedrooms Date t -1K
"'his per S granted to for the installation of a septic tangy..
at the i-�� of Address
Building Contractor 7 Address
Septic Tank Specifications: Length. Width Depth Capacity Gal.
Manufacturer's Name
Address
No. of lineslj width , 3 � in. Total Length --J�ft. ��o. of Sq. Ft.e
Type of filter material `i � Total tons used / V*x5
Minimum Requirements: House Trailer 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
or his agent.
Date of final approval
a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications,
Signed:� I" -
Septic Tank Contractor
Note: Make sketBh of disposal system on back of sheet and mail to Health Center, Mocksville,
9