P82363No. of Dedrooms ycl
DAVIE COUNTY HEALTH DMaThENT
SEPTIC TANK Phlii-IIT
Date S'"— Z 3 --
This permit is granted to for the installation of
a Septic Tank at the residence ofG%,____ Address rpt
Duilding Contractor - s..7 _ f�. Address
Septic Tani; Specifications: Length klidth Depth Capacity,9-0 Q Gal.
Manuf acturer I s Name c�%« Address
110. of lines `Width in. Total length�Ft. No. of Sq.Ft._R.,e_7-_0
Type of filter material �z Total tons used �� !?
1-dniru.i Requirements: Tank Capacity Square 11,'t. of Line
House Trailer 800 100
Two--Dedroom House 800 600
Three-Dedroam House 900 900
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
I hereby certify that the above septic tank has been installed according
to specifications.
Signed
Septic T aik Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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