P82570 Etchison StC��h�San. ���
DAVIE COUNTY HEALTH DEPARTIMENT SEPTIC TANK PERMIT
No of Bedrooms qi r Date S D
This permit is granted to " for the install io o ase is ank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal..
Manufacturer's Namee� Addre s s
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
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
6 A aA specifications.
�\ Signed:
� o ��� � Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.