Parrish, WJDAVIE COUNTY H ALTH DEPIMEI NT
SEPTIC TANK PEEd-IIT
No. of Dedrooms Date 4,,4e �2& - /' e7
This permit is granted to %1�p,/t�for the installation of
a Septic Tank at the residence of t?Y 4, Address -?- i Z11
5/
Duilding Contractor Address
Septic Tank Specifications: Length �Jidth Depth Capacity - D e) Gal,
T-Zanufacturer ' s Name Address,y��
No. of Lines 11idthin. Total length_A_I�Ft. No. of Sq,Ft, �
Type of filter material Total tons used '�(J
T,iinimua Renuirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
Two-Dedroom House 800 600
Three-Dedrocm House 900 900
No one shall install a septic tank in Davie County without a perrlit 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 A -"J-" �C
Septic Tank Contractor-
Note:
ontractor
Note : Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.