P52667 Fairfield RdDAVIE COUNTY HEALTH DEPARTA,EENT SEPTIC TANK PERMIT
Poi of Bedrooms ` Date a��--�---�
chis permit is granted to for the ir_stalla on of a septic tank_.
at the residence of Address
Building Contractor Address
SeTlt .c: T,-,.nk Specifications: Length Width_ ',Depth Capacity Gal.
Ma.nufac-.urer's Name Address u
11o, of lines / width &i'� Total Length 43 ft. i?o. of Sq. Ft�0z-
ly ae of filter material Total tons used
M.inimimn Requirements: House Tra er Tank Cap.Aioo
Sq. ft. line 40
Two-bedroom house 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 - - 2 Signed: -ita
I lZerehy 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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