P51270 Campbell5
DAVIE COUNTY HEALTH DEPART;'WT SEPTIC TANK PERMIT
No of Bedrooms .5 Date' D
This permit is granted to c for the installation of a spptic tank
at the residence of �� Address F7',T
Building Contractor Address
Septic Tank Specifi ation�s: Lengt Width Depth Capacity Gal. 967m
Manufacturer's Name L-' Address _ F
No of lines width �>i Total Lengtgth—�'Zft. No. of
Type of filter materialz� Total tons used
Minimum Requirements: Hoose Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom /use 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. proval Signed:
Sanitarian
I eby certify that the above septic tank has been inst led according t
s] cifications.
. - 3M �. , -
Signed: �)�
'� - Septic Tank/Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health// Center,
Mocksville.
I..