P11971 AllisonDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date
This permit is granted to ,% •for the installation of'a septic tank
at the residence of ��� /;t1,• -L, Address
Building Contractor-�'/�j��,� %�?�.r- �� .'Address
Septic Tank Specifications Length Width Depth Capacity Gal.
Manufacturer's Name 73 Address
No of lines �3 width -/(/in. Total Length _,�?S' ft. No. of Sq. Ft. 9 �
Type of filter material ?
��>._D Total tons used _I
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line I+00
Two-bedroom house 800 '6Q0
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:
Peptic Tank -Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.