P62371 MasonDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date 8 3
This permit is grante4 to for the instal ion of a se tic tank
at the residence of r.,"...M, Address
Building Contracto % 01DH'4$rdress `
Septic Tank Specifications: Le gth Width Dept Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons
Minimum Requirements:
House Trailer
Two-bedroom house-
Three-bedroom
ouse-
Three-bedroom house
Tank Cap.
used
Sq. ft. line 400
600
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.