P11571 CarterDA`IIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms ---1 t^c< ; /p ,r- Date
This permit is granted o Ago for the installation of a septic tank
at the residence ofdL Address
Building Contractor - Address
Septic Tank Specifications:
Length Width Depth Capacity Gal. 'dam
Manufacturer's Name Address
No of lines_ width__J_�, i( . Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tani: 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 installedLr 'ng o
specifications. `'
Signed: ,Adt � it
Septic Ta Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.