P63070 McAllister Rd DAVIE COUNTY HEALTH DEPARTIHENT SEPTIC TANK PERMIT
No of Bedrooms Date 4 - 30 - 20
This permit is granted to for the installation of se 'c tank
at the residence of Address /,
01
Building Contractor Address
Septic Tank Specifications: LAgth Width Depth Capacity Gal. 9eo
Manufacturer's Named (7,( Address
No of lines_ width in. Total Length -D ft. No. of Sq. Ft. em o
Type of filter material 41r-b ham_ Total tons used C&
Minimum Requirements: House Trailer 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.
Sigried:\ ,5� �f
s.
eptic Tank Contractor
Note: Make sketch of disposal system on back:'of sheet and mail to Health Center,
Mocksville.
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