P81570 NewsomeDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms _ Date /3 1F1,1-0
This permit is granted to for the installatio6 of 6 septic tank
at the residence of p o Address
rr--T
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. Y oo
Manufacturer's Name _ Address
No of lines_ width i . Total Length /,Z -5Lft. No. of Sq. Ft. /(5V
Type of filter material T Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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:
ez J� dJ-, 4 1 -
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.