222 Broadway Rd (2)S
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Datej , /[ )0 _
This permit is g anted to % for the i stallatiq of a s-ep�ic'tank
at the residence of Address fffe �4, yJ�
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal - %00
Manufacturer's Name Address
No of lines width in. Total Length Z� ft. No. of Sq. Ft.
Type of filter material Total tons used /01�
Minimum Requirements: House Trailer 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 in talled according to
specifications.
Signe
�� Septic Tank Contractor
0
Note: Make sketc o disposal system on back of sheet and mail to Health Center,
Mocksville.