234 Gordon DrDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
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No of Bedrooms `3 / Date
This permit is granted to 4 for the installation of a septic tank
at the residence of Address
Building Contractor �'�,�%� Address
Septic Tank Specifications: Length QQWidth Depth Capacity Gal., a2z
Manufacturer's Name &J isly-9, Address
No of lines -3 width in. Total Length 300 ft. No. of Sq. Ft. 20,0
Type of filter material Total tons used .30
Minimum Requirements: House 91 le Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900
No one shall install a septic tank in Davie County without a permit from the Health
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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 qontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.