P11870 WhiteDA`lIE COUNTY HEALTH DEPARVMKT SEPTIC TANK PERMIT
\
No of Bedrooms Date'Y c Y� f 6
•�l.• ���
`7
This permit is granted t - for the installation of a septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.:xe-6-)
Manufacturer's Name Address) � !^ c_
No of lines_ width�� ir& Total Length /-�-ft . No. of Sq. Ft .�
Type of filter material _ a--rv� Total tons used
Minimum Requirements: House Trailer �Tan1% 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 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 inst7 lled according t
specifications.
Signed:
Septic Ta Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.