P1970 Brown, DonnaDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms y- Date
This permit is granted to for the installation of a septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._ 9 6rj)
Manufacturer's Name 7e Address
No of lines_ width `31, in. Total Length --2-0 ft. No. of Sq. Ft.
Type of filter material �..,-,1� Total tons used 25'
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two --bedroom house 00
Three-bedroom house 900 900
No one shall install a septic
Officer or his agent.
Date of final approval
tank 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 ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.