P63067 Deadmon RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEMM
T Date
�), of Bedrooms y p�
"phis permit is granted to for the ir_stallat' of a septic tank_
it the residence of _-u Address
Building Contractor Address _
Septic Tank Specifications: Length Width- Depth- Capacity Gal.
,Mnufacturer's Name Address _
I3o, of lines-� widthn. Total Length _ /ODft. i:o. of Sq. Ft. ___�4_ao�
7,y%pe of filter material u Total tons used
Minimum Requirements: House T ailer Tank Cap L84 Sq. ft. line x+00
Two-bedroom house 800 600
Three-bedroom house 900 900
lo one shall install a septic tank in Davie County without a permit from the Health Officer
or hio agent
1)ate of final approval Signed:
Sanitarian
I hereby :,ertify that the above septic tank has been installed according to specifications.
Signed: -
Septic Tank Contractor
?Vote: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.