P112268 ClearyDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
lf.o,. of Bedrooms 3 Date //- z z —�
'_'_"his permit is granted to ,,�, Hca �- for the installation of aseptic tank_.
at the residence of.%'/✓c , �`� Address
Building Contractor Address _
Septic Tank Specifications: /Length Width Depth Capacity _Gal. 5? o0
Manufacturer's Name ��/� Address��/,��
No. of lines_width_2,�-in. Total Length r -%3 ft. No. of Sq. Ft. 4 �y
Type of filter material, Total tons used
Minimum Requirements: House Trailer/ Tank Cap. 800 Sq. ft. line 400
Two-bedrooia house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without
or his agent.
Date of final approval
a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
SignA:
Septic Tank Contractor
Note: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville.
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