P11870 HoltDA`JIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms Date Ido, d Z290-
This
296This permit is granted to e for the installation f a septic tank
at the residence of Address >� C.
Building Contractor Address
Septic Tank Specifications: ength Width Depth Capacity Gal. c�
Manufacturer's Name Address d
No of lines �� width in. Total Length e::� ft. No. of Sq. Ft. UD
Type of filter material , &wC. "I — . Total tons used
Minimum 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
Officer or his agent.
Date of final approval
in Davie County without a permit from the Health
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. ;
Signed:
Septic Ta Contractor
Note: Make sketch of disposal system on tack of sheet and mail to Health Center,
Mocksville.
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