P92470 Sain RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date 9—R t{— 7 �'
This permit is granted to,j)Qv;e ,t,7-11 (zo for the installation of a septic tank
at thee idence of AddressQ x,
Bui�ding4 Contractor r r iS Address o 0-l IT; Al, e
Septic Tank Specificat ons: Length Width Depth Capacity Gal. 200 _
Manufacturer's Name�Address If X
No of lines_ width__ff in. 1Total Length aa.Sft. No. of Sq. Ft. 9 00
Type of filter material 9LI-n h E _ Total tons used a s- o
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two --bedroom house 800 v,; 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: �o
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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