P4770 Hwy 64E,,- .,. .__...._..._ _..______.r.. . _� _._...
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms �— ( 9 _ Date V — % — � o
This permit is granted to"'/ u,'F . �u for the ins allation of a septic tank
at the residence of % : Address
Building Contractor u�m,�! Address
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Septic Tank Specifications: Length Width Depth Capacity Gal. a�
Manufacturer's Name I0Address
No of lines_ width in. Total Length Z.L, ft. No. of Sq. Ft.
Type of filter materialTotal tons used
Minimum Requirements: House Trailer , Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom 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 according to
specifications.
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Signed: r73iJ'.c, ---"Sept-1"c Tank Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.