Whitaker, JimmieDAVIE COUNTY HZALTH DEPART1MT
SEPTIC TANK PEM-aT
No. of Dedrooms_ Date
This permit is granted to Dog j : e // C A t (', for the installation of
a Septic Tank at the res' e e of ��
Building Contractor ter.:..'' __-Address
Septic Tank Specifications: I:ength _Width Ste• Depth " Cap -,(city oa Ga'7l �
Ilanuf acturer I s NameG � _
�u � C ��.�91.'n /1,sf �'- - -��_ Address
110. of lines_ 1, liidth___��C in. Total length Zz.S Ft. No. of Sq.Pt. 900)
Type of filter material TcA Fj e Total tons used 1/
I,ii.nimura Requirements:
House Trailer
Two -Bedroom House
Three-Dedrocm House
Tank Capacity
800
800
900
Square Ft. of Line
100
600
900
No one shall install a septic tank in Davie County without a perrait 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��c,2 r� t►�, ,,.�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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