Douthit, BobNo. of Bedrooms v
DAVIE COUNTY 1EALTH DEPARTiMT
SEPTIC TANK PL dm
Date --P— /p, t
This permit is granted to for the installation of
a Septic Tank at; the residence ofJ), J7 Address r� �
Building Contractor _
Address
Septic Tank Specifications: Length 1Iidth Depth Capacity Gal.
11anuf acturer I s Name
No. of ]fines Width in. Total length J.,: Ft. Ido. of Sq.F`t. / O
Type of filter material p�� Total tons used /C, So
1ii niiaun Requirements:
House Trailer
Two --Bedroom House
Three -Bedroom House
Tank Capacity Square Ft. of Line
800 100
800 600
900 900
No one shall install a septic tank in Davie County Vrithout a perrdt from the
Health Officer or his agent.
i
Date of final ApprovalC{ - 6 Signed;
i/ Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed 2 a
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in 11ocksville.