P12365 JohnsonDAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK Pi0iIT
No. of Bedrooms Date jot 3
This permit is granted to for the installation
of a Septic Tank at the residence of t�c,, Address
Building Contractor Address
Septic Tank Specifications: Length Width
Kanufacturer's Name
Depth Capacity Gal,:
Address
No. of lines tdidth in. Total length ft. No. of Sq.Ft.
Type of filter material Total tons used
Minimum Requirements:
House Trailer
Two -Bedroom House
Three -Bedroom House
Tank Capacity
&00
800
900
Square Ft. of Line
100
600
goo
No one shall install a septic tank in Davie Countywithout a permit from the
Health Officer or his agent.
Date of final approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed
Septic Tank Contractor
Note: I -lake sketch of disposal system on back of sheet and mail to the Health
Center in 1Iocksville.
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