5363 Hwy 601N (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms r�e-z � f e s� JRA Date
This permit is grante to for the i tallation of a septic tank
at the residence of —Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 4voc _
Manufacturer's Name c. Address
No of lines_I width i . Total Length 1SS0 ft. No. of S . Ft'. 116 oQ
Type of filter material Total tons used
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.
Signed:
Se' 'c Tank Con actor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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