P101971 Hwy 801NDAVIE COUNTY HEALTH DEPARTIMENT SEPTIC TANK PERMIT
No of Bedrooms f, 1/'P -i— Date �C�� +� %
This permit is granted to o #-"'4 for the installation of a septic tank
at the residence 0 r1A Ce Address R ✓Q�cc
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 19VIO
Manufacturer's Name ztzuty S-, % AddressIFi dleae
No of lines_ width in. Total Length &ft. No. of Sq. Ft.�
Type of filter material jtt/b��► Total tons used d o-�.
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.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.