P61667 Farmington RdDAVIE COUNTY HEALTH
DEPARTMENT SEPTIC TANK PERMIT
Tera, of Bedrooms
Date
'�:nis permit is granted to
for the installation of a
septic t __
at the residence of
Address
/
Building Contractor,
Address
Septic Tank Specifications: Leno
Width Depth
Capacity Gal.
Manufacturer's Name
Address
�
11o, of lineswidth�in. Total
Length�2as�ft. No.
of Sq. Ft. q�O
--f----------------
Ty-e of filter material#
Total tons
used
iliiilimuz❑ Requirements: House Trailer
Tank Cap. 800
Sq. ft. line
400
Two-bedroom house
800
600
Three-bedroom house 900 It
900
Pio one shall install a septic tank in Davie County without a permit from the Health Officer
or L`Ls agent.
Date of final approval Signed:
Sanitarian
Y hereby certify that the above septic tank has been installed according to specifications.
Signed: lflI
Septi Tank Contractor
Note: Make skete'._ of disposal system on back of sheet and mail to Health Center, Mocksville.: