P6768 GaitherDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERINKIT ,
No. of Bedrooms Date 6 b�
:his ?,Jiy."^..it ivs peptic tE..
0.
granted to for the irst�.la 'ono a
at the residence of%A"l �'� � ��p,�-z.�`Adizress
gip
Building Contractor � address
Septi_ Tank Specifications: Length Width Depth Capacity Gal. / o n
Mnufac: tnrer's Name �%� C� Address_ c/�,
Ho of lines��width �� in. Total Length _ / clzo ft. �:o,/ of Sq. Ft. 0, c�
Type of filter material IL:T� Total tons used
7,
Mi iia m Requirements: House Trailer Tank Capp_ 800 Sq. ft. line 400
Two-bedroom house 800 boo
Three-bedroom house 900 900
No one shall install a septic tank in Davie County ;trithout a permit from the Health Officer
or his went.
Date of final approval Signed:
Sanitarian
i hereby certify that the above septic tank has been installed according to specifications.
Signed: V&4z" L
37 Septic Tank Contractor
:sate: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.