P5668 McCallisterDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms Date—
'j''nis permit is granted to for the installation of aseptic t&__s:.
s c the residence of , y,�a%%= CGGC�-QX�L_ Address /, ��� /✓�
Duilding Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 0,0
Manufacturer's Name Address
No, of lines width in. Total Length _ ft. No. of Sq. Ft. zo a
q4 -pe of filter material Total tons used _
Min:ialm Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
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 _M Signed:
Sanitarian
hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbr of disposal system on back of sheet and mail to Health Center, Mocksville.
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