P6468 HowardDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK 'PERMIT
Tic. of Bedrooms ;ia � Date
s permadt- is granted.. to for the irst lation oi' a septic t _=
:.t the residence of �r, .�s,.w,�.., � y�;��.�r,� Adiiress
Bu _lding Contractor % _ Address
c�t i.,. T� nk Specifications: Length Width Depth Capacity______Gal, a
Manufacturer's Name Address
iio; of :lines^__i_—width in. Total Length _ r % �ft, So, of Sq. Ft. `yt d'
of filter material _Total tons used
Min'L U`r Requirements: House Trailer Tank Cap.800 Sa. ft. line 00
Two-bedroom house 800
Three-bedroom house 900 9U0
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 �.ertify that the above septic tank has been installed according to specifications.
Not e
Signed:
Septic Tank Contractor
Make sketbn of disposal system on back of sheet and mail to Health Center, Mocksville, 4,