P102969 FurchesDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
I
No of Bedrooms c .i � Date %,-11 — a I —6,
This permit is granted to for the ing tallatioXi of a septic tank
at the residence of i "jrc Address
—7
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacit-y_ Gal. %oQ
Manufacturer's Name Address 9
No of lineswidth 31 --lin. Total Length r7 coft . No. of Sq. it/ L ob
Type of filter material -l-K /�, Total tons used do
Minimum 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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: �����L
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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