3949 Hwy 64W. DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of--3cd'�� 44 6/7?
/P Date/
This permit is granted to for the installation of a septic tank
at the 5of �`f1�4 1 % oJy`P Address A01&
Building Contractor ' Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines_ width in. Total Length �ft. No. of Sq. Ft. 4Z,5-9'0
Type of filter material Total tons used
Minimum Requirements: House TraJ&er Tank Cap. 800 Sq. ft. line 400
Tiro --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.