P111166 Madison RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
T,o„ of Bedrooms <J _ Date f / ���.
r`his permit is granted to , �b < for the install ion'6f a septic tank__.
at, the residence of F - Address
Building Contractor Address
Se7)tic Tank Specifications: Lenjth Width Depth Capacity Gal.
Manufacturer's Name,_(<. S r / i (�5— Address�� _
No. of lines width in. Total Length s ft. No. of Sq. Ft. �Peej
Type of filter material �f�%�� Total tons used
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. �1,5�17 ----
Date of final approval Signed: J
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications,
Signed: C
eptic Tank Contractor
Note: Make sketc of disposal system on back of sheet and mail to Health Center, Mocksville.