P12970 GodbeyDAVIE COUNTY HEALTH DEPART14ENT SEPTIC TANK PERMIT
Note: Make sketch of disposal system on back_ of sheet and mail to Health Center,
Mocksville. Bj
No of Bedrooms u da 1 ra l� Ir -
Date
This permit is granted to
for the install?ioLnof a ee,6tic tank
at the residence of 6-t-_
;Address
Building Contractor �-
Address
Septic Tank Specifications: Length
Width Depth Capacity Gal. /a o 0
Manufacturer's Nameyi r�, % , �o
Address �,. V; l o ,
No of lines `'� width in. Total
Length 94-,� ft . No. of Sq. 'Ft. 0%
Type of filter material
Total tons used 3
Minimum Requirements: House Trailer
Tan's 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 installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back_ of sheet and mail to Health Center,
Mocksville. Bj