P111566DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
1o: of Bedrooms 1,1? Date
'alis permit is granted to for the installation of a septic ta.nk__
at the residence of Address
Building Contractor /L2ttcir'i x Address _
Septic Tank Specifications: Length Width Depth Capacity_ Gal. �P
Manufacturer's Name ��� q� Address A E
No. of lines -width in. Total Length r-�6Z A ft. Blo. of Sq. Ft. J� D r_
Type of filter material c./v&, Total tons used o2
Minimum Requirements: House Tr ler Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
ree-bedroom e 00 900
No one shall install a septic tans in Davie County without a permit from the Health Officer
or his agent.
Date of final approval/—LS "& Signed: c.�y`'��
t' Sanitarian
i hereby certify that the above septic tank has been installed according to specifications.
Signed• A�-a
ept Contractor
Note: Make sketc•. of disposal system on back of sheet and mail to Health Center, Mocksville.