P7968 LankfordDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PE-RMIT
s;r.o of Bedrooms Date 6
`!':pis permit is granted to for the installation of a septic tv._ w
"t the residence of ` !', Address < < ' �✓ �i
Bul_ding Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gale
IN-lan facturer's Name _Address
No, of lines width in. Total Length _ ft. No, of Sq. Ft.
Ty—
pe of filter material Total tons used
Ininimi.un 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 -w*ithout a permit from the Health Officer
or his agent .
Date of final approval _ Signed: i _
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, Mocksvi'_let
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