P4269 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
IT of Bedrooms �' Date
'.!'his permit is granted to Cff- s for the installation o a septic tank_
at the residence of Address�t/,//
Building Contractor Address�/g41C e
Septic Tank Specifications: Length Width Depth Capacity Gal. qpo
Manufacturer's Name SADQ:E Addresse it.c,c 7'to-n
No. of lineswidth in. Total Length o O ft. No. of Sq. Ftp m o m"'
Type of filter material #/o 4-Le�Ione -tP11er-S4xd Total tons used /6P- L4Ed Cu,y4Q
a ft l l— l a.� 010 is rL
Minimum 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.
r
Signed: _
-Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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