342 Parker RdDAVIE COUNTY HEALTH DEPARV1ENT SEPTIC TANK PERMIT
No of Bedrooms / DateJ`', /� %/
This permit is granted to �o for the installats�ii Of d septic tank
at the ¢e of Address / )14 8 �i
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._
Manufacturer's Name ` c� 7-, eL Address
No of lines_ width in. Total Length -> a ooft. No. of Sq. Ft. d�
Type of filter materials — Total tons used
Minimum Requirements: House Tra' er Tank Cap. 800 Sq. ft. line 400
Two --bedroom house 800 500
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: : 'f
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.