P52871 Spillman RdDAVIE COUNTY HEALTH DEPARTIMT SEPTIC TANK PERMIT
No of Bedrooms e Date l
This permit is granted to for the nstallatio f a eptic tank
at the residence of rS Address / /rra-
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._
Manufacturer's Name AddressJ(%` �
No of lines / width_14 Ai. Total Length , yQft. No. of Sq. F . 144
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
Officer or his agent.
Date of final approval
tank in Davie County without a permit from the Health
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.
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