834 Williams RdDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to ���n L�l�.g for the installation of a septic tank
at the residence of rfon Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 0�
Manufacturer's Name Address
No of lines width Vin. Total Length ft. No. of Sq. Ft/,,'
t. o z�
Type of filter material :i Total tons used
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.
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