P91170 Hwy 64W7 7
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date 7—//-9,o
This permit is granted to for thei stallation of a eptic tank
at the residence of �r A, n Address �/, NQckS v �`%�p 9 -OX 3 �h
Building Contractor r7u In a rs Address rMan . e
Septic Tank Specifications: Lenng�th Width Depth Ca acity Gal. fooD
Manufacturer's Name/ vi C=OKcr c Address / I, C' -
No of lines_ width in. Total Length 67,2 it. No. of Sq. Ft. ��00
Type of filter material U 111 Total tons used /6L
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 00 900
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:
ptic Tank Contractor
Note: Make sketch of disposal system on back of sheet andit to Health Center,
Mocksville.