1105 Fork Bixby Rd (2) DAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to for the installa&ion of a septic tank
at the residence of /f,.AW,� AddressRVUG P C P
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. `•
Manufacturer's Name Address`)
No of lines I width__,,in. Total Length e-FTt. No. of Sq. Ft. f� a
Type of filter material Total tons used
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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