420 or 424 Gun Club RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERiMIT
Uo, of Bedrooms Date — /
,�z
-his permit is granted to for the installation of a septic tank.
the residence of Address
Bui�dirg Contractor _ Address
Senti.t T� Tank Specifications : Length Width Depth Capacity Gal , _ �� 0
:iia: Lufacturer's Name c z�� Address
No, of lines widthin. Total Length _L,3_�L'ft. So. of Sq. Ft. qv o -�
Ty-pe of filter material A51C 1 Total tons used-
Mlnimwa Requirements: ,(House Trailer Tank Cap. 800 Sq. ft. line Por
Two-bedroom house 0 600
Three-bedroom house 900 900
:Io or shall. install a septic tank in Davie County without a permit from the Health Officer
or his went.
Date of final approval � � / Signed:
Sanitarian
T 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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