P9971 Hwy 158DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms 'f' ` -e- Date :z
This permit is granted to S ` for the installatioh of a se tic tank
at the residence of > Address
Building Contractor re%hl !j •�7�/i r ddress II
e%
Septic Tank Specifications: Length Width Depth Capacity Gal. 00 _
Manufacturer's NameAddress=
No of lines,_ width,3 in. Total Length .ado ft. No. of Sq. Ft. 119ta to
Type of filter material Total tons used -340
Minimum Requirements: House Trai er Tank Cap. 800 Sq. ft. line 400
Two --bedroom Nous c 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. Q /�/�
Signed: l �(/,�r _ d., : (e 1 �� ry4- 4
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
s• Mocksville.