P101171 CartnerDAVIE COUNTY HEALTH DEPAR'nIENT SEPTIC TANK PERMIT
No of Bedrooms a r Date
This permit is granted tofor.the i tallation of a se tic tank
at the residence of � _ -'_ Address �,,
7
Building Contractor Address �i
Septic Tank Specifications: Length Width -Depth Capacity Gal.
Manufacturer's Name
No of lines width in.
Type of filter material
Minimum Requirements: House Trailer Tank_Cap.
Two --bedroom. hous e
Three-bedroom house
Address
Total Length ft. No. of Sq. Ft.
No one shall install a -'septic
Officer or his agent.
Total tons used
800 Sq. ft. line 400
800 600
00 900
tank•in Davie County without a permit from the Health
z
Date of final approval - Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on'back of,sheet and mail to Health Center,
Mocksville.