1543 Main Church RdA LA
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms --- ; 42r' Date CS
This permit is granted to for the installation of a septic tank
at the residence of ` Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Cap/acity Gal.�16*
Manufacturer's Name Address
No of lines_ width n. Total Length Z S ft. No. of Sq. Fill � 0
Type of filter material Total tons used
Minimum Requirements: House Trai r 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 Inst lied according
specifications.
Signed: /
Septic T Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.