212 Four Corners RdDAVIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms \3 Date ,�2 — '71
This permit is grante ofor the installation of septic tank
at the residence of 4 6 1 Address'f
Address
Building Contractor yam(,(
1 „
Septic Tank Specifications: Length Width Depth Capacity Gal. c3�
Manufacturer's Name a:eAddress
No of lines width in.L' Total Length ft. No. of S . Ft.
g q
Type of filter material
Minimum Requirements: House Trailer.
Two --bedroom house
Three-bedroom house
Tank Cap.
Total tons used
800 Sq. ft. line 400
Boo 600
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.