1105 Fork Bixby Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to for the installation of a /septic tank
at the vpFAFIevige �:nGQ ,Fes �f:r ,rlc Address �ddQkc /�DfeG-- ;x 6T
GtS iX�aS
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. gmT
Manufacturer's Name co 9 q Address 3
No of lines_ vridth J6 in. Total Length 2.0 ft. No. of Sq. F (',�d'O
Type of filter material Total tons used 670
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom houses 800 600
Three-bedroom house 900 900
No one shall install aseptic 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:
Septic Tank Contractor
Note: Make sketch of disposai system on back of sheet and mail to Health Center,
Mocksville,
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