P5770 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Mn e r Date /zil9c,
This permit is granted to for the install�atio f a s ptic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 400
Manufacturer's Name �� (1 Address
No of lines_ width4qin. Total Length
,�-/� D,5ft. No. of Sq. Ft. Do
Type of filter material A (, m c�-4�i Total tons used j R - i 5c
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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.