P1667 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date
"'his permit is granted to for the irstal'ation of a septic tank__
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No. of lines__(_width 14./ein. Total Length SGS ft. Eo. of Sq. Ft.
TI pe of filter material Total tons used _
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 00
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 Signed.
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed: 62f-�
Septic Tank Contractor
Note: Make sketca of disposal system on back of sheet and mail to Health Center, Mocksville.
M L:-1
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