P5868 HoffmanDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms %-- Date
`."'his permit is granted to for the install on orf a septic tu- *S:
at the residence of Address ,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Z/� Address J��,��— —
110 of lines_.__[_width in. Total Length 351 ft. NO. of Sq. Fit.
T pe of filter material 49 o Total tons used LY �..
Mint var. Requirements: House Trailer Tank Cap t_80Q__,_....._., Sq. ft. line x+00_
Two-bedroom house 800 600
Three-bedroom house q00 900
No onF. shall install a septic tank in Davie County withoLit a permit from the Health Officer
or his agent.
Da -',.e of final approval
Signed:
Sanitarian
1- Tereby certify that the above septic tank has been installed according to specifications
Signed:
Septic Tank Contractor
Note- Malke skethh of disposal system on back of sheet and mail to Health Center, Mocksvilleo