P72871 SmithDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to for the installatiotflbf ep is tank
at the residence of /j. Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth C�apa)city Gal. �`d O
Manufacturer's Name lfJ2 Address Gr/ (,4, l
No of lines _ width_ZLin. Total Length eft. No. of Sq. Ft. 6 a o Jt
Type of filter material I Total tons used /
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom houses
Three-bedroom house 90 900
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
specifications.
Signed:
installed according to
9�1 anz� a
Septic Tank Co tr for
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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