P113071 Pulliam - CooleemeeDAVIE COUNTY HEALTH DEPARTTMTT SEPTIC TANK PERMIT
No of Bedrooms Date /1i 30 % 1
This permit is grantedAo for the i to later-oseptic tank
at the residence of t r7` 7q i� Address � prn ep fz -`
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer 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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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