P71671 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms% Tom' Date
U04
This permit is granted to a H l's for the i stallatio f asetic tank
at the residence of JyyAddress (t
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. -20,0 _
Manufacturer's Name Address `
No of lines_ width i . Total Length ,L_ft. No. of S F .
Type of filter materialTotal tons used
Minimum Requireme ts• House Trai er Tank Cap. 800 Sq. ft. line 1+00
R,'.wo--bedroom house 800 600
�--� Three-bedroom house 900 900
None sh ll 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.,
�` j 1, C Signed: %cia��e
3 � (e/�aw�T �; a Septic Tank Contractor
Note: Make sketch of Y
disposal system on back of sheet and mail to Health Center
P
Mocksville.