5132 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms r4,
Date
This permit is granted to for the i allation of a septic tank
at the residence ofeC,� r Address1011k5,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 o o
Manufacturer's Name Address? S
No of lines_ width 2 in. Total Length /3 4
A ft. No. of Sq. t.
Type of filter material.L/n - Total tons used /e7l
Minimum Requirements: House Trail �j Tank Cap. 800 Sq. ft. line 1+00
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 iIslled accgrd' to
specifications.Signed:� `/// a
Septic T nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.