P7969 County Line RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PwERMIT
�oI of Bedrooms A Date
" is permit is granted to for the installation ofa septic tank--.
— the residence of Address
Building Contractor Address
Ser)tic Tank Specifications: Length Width Depth Capacity Gal. 9�00
���iQD4��zufacturer's Name Address 4qz�,
No, of lines^_.Lwidth "� TTo--tal Length o?�t . No. of Sq. Ft. O oy _
Type of filter material � _�4Q Total tons used /!g
:+I.i.nimuza
Requirements: House Trailer Tank Cap. 800 Sq. ft. line 2400
• Two-bedroom house 800 600
Three-bedroom house 900 900
No one
or his
Date c
stall install a septic tank in Davie County without a permit from the Health Officer
agent.
final approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note- Make sketc': of disposal system on back of sheet and mail to Health Center, Mocksville.
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