121 Holman StDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date , !7,ro'
permit is granted to for the insta at�gn of ta septic tank_.
-t the residence of Address
Building Contractor V— Address
Septic Tank Specifications: Length Widthr Depth Capacity Gal,
10'anufacturer's Name Address
No, of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used _t
TO D,CiI� fan k ;r'sa! f'.
T+iinimr. Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 6C0
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 sket"-. of disposal system on back of sheet and mail to Health Center, Mocksville.