P82867 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
i!o, of Bedrooms f-�r.�vL Date
'his permit is granted to for the installation of a septic tank_
at the residence ofuLx& Address
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.
lype of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. Sq. ft. line L 00
Two-bedroom house 00 600
Three-bedroom house900 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
T hereby certify that the above septic tank has been installed according to specifications.
Signed: tlz a�->»2
Septic Tank Contractor
Note: Make sketcl: of disposal system on back of sheet and mail to Health Center, Mocksville,