P1972 Howardtown RdDAVIE COUNTY HEALTH DEPART11ENT
No of Bedrooms
This permit is granted to for the
at the residence of .M, ?'I%3 Address
—,r
Building Contractor Address _
Septic Tank Specifications: Length Width' Depth Capacity Gal. 9,00
SEPTIC TANK PERMIT
Date
installation of a septic tank
Manufacturer's Name Address
No of lines in. Total Length ft. No. of Sq. Ft. 41a D
Type of filter material Total tons used /
Minimum Requirements: House Trailers Tank Cap. 800 Sq. ft. line 0)
Two-bedroom house- 800 600
Three-bedroom house 00 900
No one shall install a septic tank in Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. /Q�
Signed: 6�cj'yi ea
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.