205 County Line Rd (2)DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms
Date jot
—
% -- %Z
This permit is grant t
for the installation
of a septic tank
at the residence of
_
Address A4:
Building Contractor
Address
Septic Tank Specifications: Length
Width Depth Capacity
Gal. / !J 5 -
Manufacturer's Name `
jd,t&7'�.,Address
No of lines[_ width in. Total
Length 6LZ ft. No. of
Sq.
Ft. GAO
Type of filter material O O
Total tons
used
oi/
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.