P112367 Rainbow RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERiMIT
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�.c.; of Bedrooms j�'a.�el f�r�w< Date
phis permit is granted to for thei.stallatiUT,
a septic tank.
:t 'the residence of ��f j�Q yt,z_� Address Vii, ��-�J
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Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 1-TI-1
Manufacturer's Name Address
No. of lines / width (3n. Total Length /,3-/ft. No. of Sq. Ft. L d-b"
Type of filter material Total tons used /
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without
or his agent.
Date of final approval
I hereby certify that the above septic tank has been
Signed:
a permit from the Health Officer
Signed:
I`
Sanitarian
installed /according to specifications.
Septic Tank Contractor
IJote: Make skelbh of disposal system on back of sheet and mail to Health Center, Mocksville.