P6768 TrivetteDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEitMIT
T.
of Bedrooms �, Date
`.�iis pe_-�.it is grantedat for the irs lation asepticis the residence of % „Address
.
Building Contractor _ Address
SeDt is Tank Specification: Length _ Width Depth Capacity Gal.
�ian7w��,.cturer's Name t Address �y �.
I?o, of lines__f _width �' in. Total Length ft. No. of Sq. Ft.
T;,rpe offi l er material Total tons used
Hevirements: House TrailTank Cap. a00� Sq. ft. line ?+OU
Two-bedroom house 00er �0
Three-bedroom house 900 900
!o one shall install a septic tank in Davie County rithout a permit from the Health Officer
or tis anent.
l;f; tee: of final approval � Signed:
Sanitarian
:iy certify that the above septic tank has been installed according to specifications
Signed:
Septic Tohk Contractor
?ot Make sketc: of disposal system or. back of sheet and mail to Health Center,. Mocksville.
i'