P11866 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
r"o., of Bedrooms .3 Date
a:Zis permit is granted to for the installation of a septic tank_.
at the residence of Address
Building Contractor Address o
Septic Tank Specifications: Length Width Depth Capacity 9 65 Gal.
Aanufacturer's Name A.Address
i
110,, of lines^_width_ fS in. Total Length dc;2 S ft. Pio. of Sq. Ft. 900
Type of filter material
Total tons used
T+li_nimum Requirements: House Trailer Tank Cap. £300 Sq. ft. line 400
Two-he_droom house _80 600
Three-bedroom house 9Oo 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
TE hereby certify that the above septic tank has been inst 11e according to sp/ecifications.
Signe
g J
eptic Tank Contractor
Note: Make sketci; of disposal system on back of sheet and mail to Health Center, Mocksville.
����
ti,,n��