P61868 BooeDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms _ �,
Date
...his permit is granted to ✓' �2 for the installation of a septic tams__
;it; the residence of r j �8-� _ Addressley, S
Bu.l ding Contractor Address
Se-nt.ic Tark Specifications: Length Width-_ Depth__ Capacity Gal. y �a
Ma:,Lfacturer's Name _ �_ r� Address
No, of line s_T_L—width--g2in. Total Length � LV ft. Pio. of Sq. Pt.
A
Type of filter material Total tons used �
Minynua Requirements: House Trailer//
railer 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,speecifi-cations.-
Signed: ✓ _
Septic Tank Contractor
Note: Make sketci-. of disposal system on back of sheet and mail to Health Center, Mocksville.