P81167 BennettDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
TY
-) , of Bedrooms Date// -
`"his permit is granted to c? _ for the installation of a septic tams-.
at the residence of � Address
Building Contractor AddressU, (Z.
Septic Tank Specifications: Length Width Depth Capacity Gal. �D
Manufacturer's Name �,� Address
No. of lines_Lwidth_±L a in. Total Length ��25 ft. No. of Sq. Ft. 9 o
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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:
.Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksvillc