P61564 Hwy 801SDAVIE COUNTY HLALTH DEPARVIMT
SEPTIC TANK PM.1IT
No. of Dedrooms ;?— Date 1 ,"� / S - / L/
This permit is granted to !? ,dor the installation of
a Septic Tank at the residence of ��{- �" Address A _ 1_ -✓ p
Building Contractor
Address
Septic Tank Specifications: Length LLlidthDepth wl Vr Capacity d o Gal. �
Manuf acturer t s Namei,s..• D Addre s s s '� _
No. of lines Width36 in. Total length 00 Ft. No. of Sq. Pt. �U
Type of filter material Total tons used
riinimum Requirements: Tank Capacity Square Pt. of Line
House Trailer 800 100
Two -Bedroom House 800 600
Three-Dedro= 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 _��o J��2
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.