P31770 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
J
No of Bedroomsra : le c- Date/91 /�111>0
This permit is granted to -,(..a k /l' for the installati'n of a septic tank
at the residence of�ir r Addressj�,
Building Contractor Address
Septic Tank Specificatiops: Length Width Depth Capacity Gal.??o
f/�/
Manufacturer's Namey'-� Address 7''
No of lines_ � width �' i Total Length
3 � ft. No. of Sq. F . i 9
Type of filter material - t P vu, L- L.p Total tons used ?C),10--
Minimum Requirements: House Trail 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: 0--,L-1"� �,�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.