P101366 WagnerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Tio, of eels^ 3 (��i _ Date
This per nit is granted to 7��u-! o . / (a for the installation of a septic tangy;
at the: ruidence of Address
Dui -ding Contractor Address
Serotic Tank Specifications: Length Width Depth Capacity Gal.
f. rarr,:facturer° s Name Address
!o of liner width in. Total Length ft. Eo. of Sq. Ft.
ltrp ( of fi:i. er material Total tons used
m n Requirements• House Trailer Tank Cap. 800 Sq. ft. line x+00
• Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
? t l -e of final approval / o - 3 - b Signed:2 f
t, Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note> Make skettr: of disposal system on back of sheet and mail to Health Center, Mocksville.