P22168 GaitherDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'o of Bedrooms _ Date
t:c.is permit is granted to for the installation of,J a septic tan _.
_�t, the residence of t LZI-t Address
Building Contractor Address
Septic Tank Specificatio s: Length Width Depth Capacity Gal.
Manufacturer's Name Address
Ido. of lines % width (:.n. Total Length _V st ft. No. of Sq. 4t. &3 CN
1;7pe of filter material Total tons used f i.
14.1.nimum 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
or his agent:,
Date of,final approval
tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
hereby certify that the above septic tank has been installed according tf specifications.
Signed:✓Z��`'i�
Septjcf Tank Contractor
Vote: Make sketc,. of disposal system on back of sheet and frail to Health Center, Mocksville.,