869 Hwy 801N (2)DAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms /1-0 c6 f Date
This permit is granted o for the installation of a septic tank
at the residence of (:12 ` Address
Building Contractor Address
Septic Tank Specifications: Length Width. Depth Capacity pp Gal. 4100
Manufacturer's Name g��Address 3
No of lines width(�i.n. Total Length LA&ft. No. of Sq. Ft.
Type of filter material Total tons used
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: L&S—:z
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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