P51171 CarltonDAVIE COUNTY HEALTH DEPARVIENT SEPTIC T P
No of Bedrooms Date''-- --� This permit is granted to ;s for the ation of septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Dept pacity Gal.
Manufacturer's Name Ad� ess 3
No o in idth al Length jcrD ft. No. of Sq. Ft d D
�e of filter material To alt s used
Minimum Requirements: ouse railer Tank Cap. Sq. ft. line 1+00
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: diz�P-A;
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.