P101568 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
`.'o., of Bedrooms 7 � � Date
_'his permit is granted t�rn.r2y I`-�i for the installation of a septic tank ..
at the residence of CC c c c (' + /' Address I� �V , c
Bui ding Contractor Address ,�
Ser)tic Tank Specifications: Length Width Depth Capacity Gal. `t 6rl
Manufacturer's Name Address
ITO� of lines idth �z S in. Total Length M /S Oft. No. of Sq. Ft.
11.'ype of filter material Total tons used y �
.4-_nimur requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
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, his agent.
Date of final approval Signed.
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed: /l 4—
Sep,.ic Tank Contractor
Note: Make sketbit of disposal system on back of sheet and mai,/toHealth Center, Mocksville,