183 Main Church RdDAVIE COUNTY HEALTH DEPAR'9ft1ENT SEPTIC TANK PERMIT
No of ooms
� Date
This permit is granteA to for the installation ota peptic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. Um
Manufacturer's Name Address `
No of lines _/ width-Oin. Total Length �ft. No. of Sq. Ft. �6
Type of filter material % Total tons used 2 /y
Minimum Requirements: Hou e/Trailer 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 installed according.to
specifications.
Signed: �
Septic Tank Conactor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.