P22571 Hwy 158DAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
e�
No of Bedrooms �Y _ Date
This permit is granted to &s R/hS for the installation of a septic tank
at the residence of FtYirrc ps rhe ' Address� f� a c /cs
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. Rec
Manufacturer's Name C/�
L Address .3gtuf
No of lines_, width 4.' Total Length s3 ft. No. of Sq. Ft .
Type of filter material Total tons used f�
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 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. /
Signed:j'I�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.