P9966 BlackwelderDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'zo, of Bedrooms Date
:'his permit is granted to for the installation of a septic tan's._.
at the residence of Address
Building Contractor Address _
Septic Tank Specifications: Length Width Depth__ Capacity Gal _
D'�azufacturer's Name ��Address�y,�
I?o. of lines gC width Total Length ___,j ft. ^'o. of Sq. Ft,
Ty -,_•e of filter material Total tons used
.9in.iminr. Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
t0 -bedroom house 800ree-bedroom house 900 9O0'
G:)
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his went. <
Date of final approval fes` - J 6 Signed: c e��`_"
/ Sanitarian
I hereby certify that the above septic tank has been installed accordingtoo Jspecifications.
Signed:��__���
Septic Tank Contractor
Note: Make sleet :� of disposal system on back of sheet and mail to Health Center, Mocksville..