481 Dulin Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
.:o, of Bedrooms , Date
This permit is granted to
7-a.i� for the installation of a septic tank,.
at the residence of � Address � 7
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity______Gal. ;?Q0
Manufacturer's Name Address
T .. r K
N ( .y
o,. of lines width in. Total Length �ft. X10. of Sq. Ft. 5�a
' Tpe of filter material Total tons used JSP
?inimun Requirements: House Trailer Tank Cap.40V
Sq. ft. line k00
Two-bedroom house 00
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 Signed:
Sanitarian
i hereby certify that the above septic tank has been installed according to specifications
Signed:
Septic Tank Contractor
Note: Make sketb`t of disposal system on back of sheet and mail to Health Center, Mocksville.