281 Double A Trail (3)IV
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK ERMIT
No of Bedrooms -,,3 Date _ 2,2 %0
This permit is granted to or the irlpt.allation of a septic/tank
at the residence of ` Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. O�
Manufacturer's Name Address
No of lines �� width_,Jj�o in. Total Length _off ft. No. of Sq. Ft �o-D
Type of filter material 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:&��,��,l e&�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.