P73168 Ijames Church Rd1R),. of Bedrooms
`."hi:; permit is
DAVIE COUNTY HEALTH DEPART=T SEPTIC TANK PERMIT
Date ( ':�
granted to for the ir_stallatlo of a septic tank --
at the residence of Address 61L
Building Contractor Address
Septic Tank Specifications*. Length. Width Depth Capacity
Manufacturer's Name Address
No. of lines f widthl�ln. Total Length l �� ft. No. of Sq. Ft . G a dd _
Type of filter material -� to Total tons used
Mo-nimum 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 sleet h of disposal system on back of sheet and mail to Health Center, Nocksville,
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