P92568 Excalibur LnDAVIE COUNTY HEALTH DEPARTTN,=T SEPTIC TANK PERMIT
?ca, of Bedrooms Date
.his permit is granted to for the installation of a septic tank _
at the residence of �i��� ��� Address ,�T,
Building Contractor k)_a-a-a-( °4, Address
Septic Tank Specifications: Length Width Depth Capacity % Gal. d
f
Manufacturer I s Name O r
,%`i �., � Address
No, of lines. � 1 width in. Total Length _....
O ft. No. of Sq. Ft. Sr�0
'I -pe of filter material 7 ,o�,r ,L� � ,..� Total tons used / y
Minimum Requirements: House Trailer / Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 boo
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.
Dae of final approval Signed:
Sanitarian
.% hereby certify that the above septic tank has been installed accordin to �p- cif ications.
Signed:
Septic Tank Contractor
Note: Make sket1,. of disposal system on back of sheet and mail to Health Center, Mocksville,
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