P92068 LeazerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
uo of Bedrooms Date o
T
"':r,is permit is granted to for the installation of a septic tank --
at the residence ofAddress 1�
iiui .ding Contractor ;�.,.� C� (�� Address%._
Serotic Tank Specifications: Length 6 i th_ __ Depth Ca acity_ .
Manufacturer's Name T3_a,,,4 X <%-1 A _ Address�'��-u
No,. of lineswidth in. Total Length ft. Uo. of Sq. Ft,
Type of filter material Total tons used
�jinimum Requirements: House Trailer. Tank Cap. 800 Sq. ft. line I+00
Two-bedroom house 800 600
Three-bedroom house 900 900
:oto 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 specifications,
Signed:
Septic Tank Contractor
Ilote, Make sketc'; of disposal system on back of sheet and mail to Health Center, Mocksville.
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