P82967DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date
...his permit is granted to for the installation of a septic tank -
,t
ank -:t the residence of ? Address
Building Contractor Qw Address
Septic Tank Specificatio s: Length Width Depth Capacity Gal. a o
Manufacturer's NameJ% 7, Lo LeAddress ,
Idc. of linesC9,_width _L—in. Total Length ft. No of Sq. Ft. f op
•Type of filter material Total tons used %
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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 cyt: /�1 , Signed: et
i
Sanitarian
hereby certify that the above septic tank has been installed according to specifications.
Y
Signed:
S ptic Tank Contractor
Note: Make sketbh of disposal system on back, of sheet and mail to Health Center, Mocksville,
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