P11769 Hwy 158DAVIE COUNTY HEALTH DEPARVENT SEPTIC TANK PERMIT
No of Bedrooms l r'a f/e r ` Date -- �% 4
This permit is granted tou.7t— for the installation of a septic tank
at the residence of V Address
Building Contractor Address /SS'',�eu�., /G
Septic Tank Specifications: Length Width Depth Capacity Gal. O
Manufacturer's Name'°eL Address
No of lines_ o,�_ width 3,lin. Total Length ft. No. of "Sq. it eoo
Type of filter material-�S`i�n�i_.L 1��1QL Total tons used
Minimum Requirements: House Trail r 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 ins lled according to
specifications.
Signed:
Septic eank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
� �k,5 V,,; Ile: