P62667 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
T1o., of Bedrooms _ Date
pernit is granted to a ` ' � / �vn, for the installation of a septic tank-.
at the residence of� r Address
Building Contractor ` Address
Set)tic Tank Specificati ns: L gth Wi th Depth Capacity _Gal,
:Manufacturer° s Name ! 624� Address
Nc.. of lines__'� width Total Length ho. ft. bio. of Sq. Ft. Z eM
Type o:f filter materials Total tons used
i-;in;_:aum Requirements: House Tr iler Tank Cap. 800 Sq. ft. line, it00
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 h- s a7,ent .
Date of final approval Signed: _
Sanitarian
Z hereby certify that the above septic tank has been installed acicording to specifications.
Signed: -
Septic Tank Contractor
Note: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville.