148 Cana RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms \
Date 10— 4P-- 7 0
This permit is granted
to
for the installation of a
septic tank
at the residence of
4wreKee
Address
Building Contractor
Address
Septic Tank Specifications: Length
Width Depth Capacity
Gal. aD
Manufacturer's Name
Address
No of lines j vridth
3 ' n. Total
Length eft. No. of Sq. Ft.
Type of filter material
Total tons used
3 0
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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