P8470 Bracken RdJ
DAVIE COUNTY HEALTH DEPARTIMENT SEPTIC -TANK PERMIT
No of Bedrooms Date qa v CJ -101' „ D _
This permit is granted to 4 ht for the installation of a 5 tic tank
at the residence of Address
Building Contractor Q)" Cc. Address
Septic Tank Specifications: Length Width Depth Capacity Gal. a
Manufacturer's Name Address
No of lines width in Total Length ft. No. of Sq. Ft. 9db
Type of filter material
Minimum Requirements: House Trailer Tank Cap.
Two-bedroom house
Three -bedroom -house -
Total
800
800
900
tons used
Sq. ft. line 400
600
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.