P7970 SmithDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms DateI--
This permit is grant t j!Wjr-' for the installer ion n o � septic tank
at the residence of Address �_,.
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. O
Manufacturer's Name mac c �.1 J Address
No of lines_ L width in. Total Length / o ft. No. of q. Ft. �eDO
Type of filter material 7 Total tons used /a
Minimum Requirements: House Tr Pd.er Tank Cap. 800 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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: Z,4�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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