P1970 Pennington, GeraldDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Q, of Bedrooms 3 We
This permit is granted to for the installation o'f a septic tank,.
at the residence of QW & �A11fai�_ Address
Building Contractor _ =nmA ��� � Address
Sel tic. Tank Specifications: Length _Width __ Depth Capa.city_Gal. � 9
,�Iaxauf'ac turer' s Name _Address__
Q. of lines_--- 1 width in. Total Length _ Zft. i'Io. of Sq. Ft.
'Py- of �:ilter material 2`i ;7 Total tons used c?
Minimi.zn Requirements: House Trailer Tank Cap. 300 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 e Signed:
Sanitarian
1 heresy certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketc of disposal system on back of sheet and mail to Health Center, Mocksville.
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