976 Wyo RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms / a ; / r Date D -- �O
This permit is grante to for the installation of a septic tank
at the residence of Address?l�.r
Building Contractor Address
Septic Tank Specifications: Length- Width Depth Capacity Gal. 2a D
Manufacturer's Name �" _ Address
No of lines / width4�',/in. ot��a``l Length Io oft. No. of Sq. Ft. a o
Type of filter material __ 0 Total tons used
Minimum Requirements:[ -To use Trailer an_�s �.8 Sq. ft. line 00,
Two-bedroom ous a 00
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. � w ^ f�t�,
Signed: j
Septic Bank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.