P5567 Mocks Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms 3 Date�—
:his permit is granted to for the ir_stallao of a septic tank.
�t the residence of `�!�r� Address z�
Building Contractor ,x Z, Address
Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 50.0,0
Tan-afacturer's Name > Address 7
No., of lines width 36 in. Total Length ft. No.•of Sq. Ft. � a�
Type of filter material Total tons used
Minim= Requirements: House Tra} er Tank Cap. 800 Sq. ft. line 400
Two-bedroom house -800 6C0
Three-bedroom house 900 900
No one
or his
Date c
shall install a septic tank in Davie
agent.
final approval
County without a permit from the Health Officer
Signed: e. ,t�i�-cam_
Sanitarian
hereby certify that the above septic tank has been installed according
to specifications.
Signed:
Septic Tank Contractor
Note: Make sketb' of disposal system on back of sheet and mail to Health Center, Mocksville.