570 Chinquapin RdSigned:
Septic Tank Contractor
Note: Make sketl., of disposal system on back of sheet and mail to Health Center, Mocksville.
h
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERiMIT c�
EI:)� of Bedrooms
Date
"his permit is granted to
for the installation
of a septic tank_
at the residence of rJj2c*�,1�.� � l c c�c���y�,
Address R7�
Building Contractor
Address
Septic Tank Specifications: Length Width
Depth Capacity
Gal.
Manufacturer's Name
Address
No.. of lines width in. Total Length
ft. No. of Sq. Ft.
T;me of filter material
Total tons used
Minimum Requirements: House Trailer Tank
Cap. 800 Sq. ft.
line 1+00
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 sketl., of disposal system on back of sheet and mail to Health Center, Mocksville.
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3