358 Spillman RdDAVIE COUNTY HEALTH DEPARTPSENT SEPTIC TANK PERMIT
No of Bedrooms % Date
This permit is granted to for the installation of a Septic tank
at the residence ofC Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines_ width_ Total Length ft. No. of Sq. Ftd�
Type of filter material iL-L Total tons used 4c,-Xz�- 70 -1 --
Minimum
0-�Minimum Requirements: House Tra' er Tank Cap. 800 Sq. ft. line 100
Two--bedr om 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�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.