P91770 No Creek RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms e' ` rl*� Date 2—,12 — 7
This permit is granted ,% , Lel, , for the ins allation of a sept' c tank
at the residence of Address ZP e 3. L
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._
Manufacturer's Name a f� Ca Address_L
No of lines_ width in. Total Length o oft. No. of q. Ft. tfoo
Type of filter material p Total tons used T
Minimum Requirements: House Trailer Tam's Cap. 800 Sq. ft. line 400
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.
Signed:
Se is Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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