P61170 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms �gife Date D
This permit is granted to for the in tal ion of a ieptic tank
at the residence of J e r i or Address
Building Contractor Address
Septic Tank Specifications:: Length Width Depth Capacity Gal.
Manufacturer's NameXx % , C�. f Address
No of lines_ width in. Total Length J2_�( ft. No. of Sq. Ft. `/da
Type of filter material Total tons used
Minimum Requirements: House Traer Tank Cap. 800 Sq. ft. line x+00
i
Two--bedrom house 800 600
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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed accord'ng to
specifications.
Signea-�Azft4j -erxl-'
S is Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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