P5964 Wandering LnDAVIE COUNTY H13ALTH DE-PAR71LMT
SEPTIC TANK PM-aT
No. of Dedrooms Date v-- q — 6 t%
This permit is granted to%f a"TjAfor the installation of
a Septic Tank at the residence of Address
Duilding Contractor _ / R , Address p
Septic Tank Specifications: Length ajWlidth 2,& Depth. b Capacity2Qd Gal.
Manufacturer's Name Address
No. of lines Width *3e,
e, in. Total length 3 oa Ft. No. of Sq. Ft. Y6 a
Type of filter material Total tons used 30.°
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
Two -Bedroom House 800 600
Three-Dedrocm 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. QD
Signed
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.