Smith, OscarDAVIE COUNTY HEALTH DEPAR'I`iMT
SEPTIC TANK Phn-aT
No. of Dedrooms ` .1 Date _ ,= 3 f _ � Jr
This permit is granted to for the installation of
a Septic Tank at the residence of .� � Address
Duilding Contractor ��Address
Septic Tank Specifications:, Length TTidth Depth Capacity oa Gal.
I-IanufacturerIs Names}„'-- �/,c„1 Address
No. of lines Width in. Total lengthFt. Ido. of Sq,rt.__t90 0
Type of filter material �,�.4, Total tons used
%iinimirm Requirements: Tank Capacity Square rt. of Line
House Trailer 800 100
Tttic-Dedroom House 800 600
Three-Dedroa-� House 900 900
No one shall install a septic tank in Davie County irithout 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 �' ��v. ,sS"e9 4
Septic Tank ContNactor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.