P91967 Fairfield Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
17o. of Bedrooms Date •—/ r-/0 _
?nis permit is granted to xc. 1. for the installation of a se tic tank_.
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 b,0
Manufacturer's Name j Address
No. of lines___,width in. Total Length ,15"&> ft. No. of Sq. Ft. 40-0
Type of filter material _ ' Total tons used �� L f�- y
Minimum Requirements: House Tr iler Tank 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 installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back' of sheet and mail to Health Center, Mocksville.
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