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DAVIE UUUATI rii:JAUIh lJl;rf,n'1'i V'r
SEPTIC TANK Pth"'� aT
No. of iedrooms ,?j
This permit is granted to
a Septic Tank at the residence
peptic
installation
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Tank Specifications: Length ���Tidth Depth Z24 Capacity D Gal.
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T-lanufactureris Name _ Address Q
No. of lines Ulidth in. Total length Ft. No. of Sq.,1~t. ;��
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Type of filter material i�.fJ `� .Rc �Q , Total tons used _ _7D
Iiiniiara Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
Tttic--Bedroom House 800 600
Three-Dedroom House 900 900
No one shall install a septic tank in Davie County tirlthout 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 in4alled actor ' ng ,9
-
to specifications. ��
'V_ d�V�er r
Signed
-7 S cV//Itractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.