P1967 Madison RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
o, of Bedrooms Date
`!,his permit is granted to for the installation of a septic tank__
at the residence ofk c'-�C-d-� Address
Building Contractor Address
Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No. of lines width in. Total Length ft. Yo. of Sq. Ft.
'I`ve of filter material Total 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 beeninst led accordi. j�to spe ifications.
Signed: C~�=�-E L---�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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