P1972 Hwy 158DA`JIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms
Date /— 2 — 2
�Z-
This permit is granted to
for the installatioon of a
septic
tank
at the residence of
Address 1 7 /i/0 Pt
Building Contractor -S� ��
Address
Septic Tank Specifications; Length
Width Depth Capacity
Gal.
Manufacturer's Name �1� ?7�-�m,L�
Address 3 /a
No of lines width in. Total
Length ft. No. of Sq. FV
Type of filter material
Total tons. used
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.