P52068 Milling RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
I;o . of Bedrooms
Date
`iris permit is granted
to for the insta la ' n of septic te._:
at the residence of Address %✓I��,..
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No. of lines width in. Total Length ft. No. of Sq. Ft.
Tr, -pe of filter material Total tons used
Mi.ni:= Requirements: House Trailer Tank Cap.. Sq. ft. line POOOO
Two-bedroom house 0
Three-bedroom house 900 900
Po 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
1 hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville„
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