P8868 Baltimore RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms `
r ,
Date �" S`���
7h -Js permit is granted to
G0,,
8&4
for the installation of
a septic ta-4'*
a'u the residence of 0 �
�
Address
A' -Z ! ,
Duilding Contractor
Address _
Septic Tank Specifications: Length
Width
Depth
Capacity_ Gal.
7 0
Manufacturer's Name
Address
� r
No. of lines LWidthJ �, in. Total Length
_ /- f ft. No.
of Sq. Ft.
'I Yps of filter material�`r to c
Total tons
used
M
Minimum Requirements: House Trailer
/.t
( Tank Cap. 800
Sq. ft. line
100
Two-bedroom house
800
600
Three-bedroom
house
900
900
i+o 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
Ihereby certify that the above septic tank has been installed according to s ifications.
Signed: L,, _
Septic Tank Contractor
Note: Make sket*n of disposal system on back of sheet and mail to Health Center, Mocksville.
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