P42170 Hwy 601SDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
-' le �r- Date '/ - 02 0- �0
No of Bedrooms / T'�
This permit is granted to for the i s llatiioon of ase is tank
at the residence of (Y,eor• ; q w-5; Address
Building Contractor Address
Septic Tank Specifications: Lengths a" WidthS-t Depth_�,LCapaacity Gal. 'o o _
Manufacturer's Name -sl -2f- Address R1,
No of lineswidth in. Total Length [a o ft . No. of q. Ft.
Type of filter material --Yq-- /0 _6 r Total tons used -! (2
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+0
Two --bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit
Officer or his agent.
Date of final approval Signed: _
from the Health
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.