P71870 SmithDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms --3 Date �/.—r�� '� o
This permit is granted to for the in allat'on of a septic tank
at the residence ofIja y,r Address.r��t.o
Building Contractor ,!& Q�dress
Septic Tank Specificat' ns: Length Width Depth Capacity Gal. X6c>
Manufacturer's Name Address
No of lines width 3!6 i . Total Length -?eft . No. of Sq. Ft. ,r O
Type of filter material Total tons used
Minimum Requirements: House Tr ler Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a
Officer or his agent.
Date of final approval
septic 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.
c�
Signed: �'�i''1�f
S tic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.