P2171 Prison Camp RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date — �/
This permit is granted to , , ,for the installation of a septic tank
at the residence of Address,/,��Q
Building Contractor
1��ddress
Septic Tank Specifications: Length Width Depth Capacity Gal. ),oa
Manufacturer's Name ,z � r Address
No of lines_L width in. Total Length ft. No. of Sq. Ft. 5'eZ
Type of filter material Total tons used �3f
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:,,, J ►Yv'�
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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