330 Shady Knoll LnDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANKFPation4of
`t
,Co. of Bedrooms p2 Date j�
'"his permit is granted to for the ir_sta a septic tangy.
s:L the residence of le J' -I roa cl Address -e-2-f
� -(9-
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address �,������- 4�- r
No., of lines_width in. Total Length ft. No. of Sq. Ft.
Type of filter material i C,>_Total tons used 14
M-inimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100
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 ce-rtify that the above septic tank has been installed according to s ecifications.
Signed�C
Septic T Contractor
note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville,