2172 Milling Rd (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms — _ Date 2 _
This permit is gran ed to or the 4itiallaiiop,,Va se is tank
at the residence o Address `
Building Contractor Address .
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. otal Length ft. No. of Sq. Ft.
Type of filter material -%tal tons,"Uped
Minimum Requirements: House Trailer Tank Cap.'s 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
r
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.