1304 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date /0--20—
'.?,his
O---2o--"his permit is granted to for the installation of a septic tank
at the residence of Address %% .
Building Contractor ,% Address
Septic Tank Specifica ions: Length Width Depth Capacity
Manufacturer's Name ��.A��-�� Address
Iuoo of lines width�6in. Total Length va ft. ro. of Sq. Ft.
Type of filter material Total tons used .30-t
Minimum Requirements: House Trai er Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 60o
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:
Septic Tank Contractor _
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.