P52270 JonesDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms o� Date
This permit is granted to for the installation of a septic tank
at the residence of , J oh es Address ��, T
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.,100o
Manufacturer's Name Address 3
No of lines �� width, i Total Length oo ft. No. of q. K. o o
Type of filter material s Total tons used gyp,!go
Minimum Requirements: House TraileTank Cap. 800 Sq. ft. line 1+00
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
specifications. �
Signed: � % • �'
Septic Tank Con ractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.