P11767 SmithDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
To,, of Bedrooms
Date -
".'his permit is �
p granted to b�� '� •� . <<S',
for the installation of a septic tank_,
r
at the residence of Q_
Address
Building Contractor [4.� c-J!z
Address
Septic Tank Specifications: Length Width
Depth Capacity Gal.
Manufacturer's Named os , % , C�`-
Address_
ITO, of lineswidth in. Total Length
a, ) ft. No. of Sq. Ft.
Type of filter material
Total tons used
M.L.nimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house
800 6o -Q_
Three-bedroom house900
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
1- hereby certify that the above septic tank has
been installed according to specifications.
Signed:
e Septic flank Contractor
Note: Make sketb': of disposal system on back of sheet and mail to Health Center, Mocksville,
t/ U �
i