186 Chinquapin Rd (2) DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms -3 Date 3- .30 --7 e
This permit is granted to for the i s allation of a sic tank
at the residence of _ Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity,.�j' Gal. 9a�
Manufacturer's Name Address
No of lines (N2width_,F6 A'. Total Length c3 ab ft. No. of Sq. Ft'. �14d-D
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two--bedroom house- 800 600
Three-bedroom house rr 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.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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