P111067 McClamrockDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
;�o, of Bedrooms Date i /'
`.''his permit is granted to , �=` — for the installation of a septic tans,
at the residence of Address
Building Contractor4 1—n Address
Septic Tank Specificati s: Length Width Depth Capacity Gal. DO
T�•irnufacturer's Name Address
Tdo. of lines_ width in. Total Length _ ft. No. of Sq. Ft.
Type of filter material Total tons used _
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
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.
Date of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
L'