P4170 WhiteDAVIE COUNTY HEALTH DEPARVIENT . SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to for the insta lation of a septic tank
at the residence of�Q,s_s'_ Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.% ocn-
Manufacturer's Name Address ��
No of lines`width) Total Length /ao ft. No. of Sq. Ftf�
Type of filter material -.:�-C.o _ Total tons used
Minimum Requirements: House Trailer Tank. Cap. 800 Sq. ft. line 1+00
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: t1, r f,
S Q -
is Tank ntractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.