P8764 Sain RdDAVIE COUNTY HuALTH DEPARTIMT
SEPTIC TANK PER. -aT
No. of Dedrooms _ Date Cldaa , 7—
&17
This permit is granted to ",., ,or the installation of
OF
a Septic Tank at the residence of Address
Building Contractor & �ddress
�
r
Septic Tank Specifications: Length �_tilidth E2 Depth 6 4'� Capacity 0 () Gal.
Manuf acturer t s Name & r Addre s s f J1-
No. of lines Width 3 ( in. Total length 13 00 Ft. No. of Sq.Pt. LY60
Type of filter material Total tons used 3 D
lfiinimm Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
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.
Signe. �Z
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.