960 Yadkin Valley RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
tf;�� of Bedrooms Date
<::zis permit is granted to for the installation of a septic tank'.
,rt the residence ofP.Q Address
Building ContractorAddress
Septic Tank Specificationsz Length Width Depth Capacity _Gal. 9
Manufacturer's Name � � Address
No. of lines width n. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
-.9 D
Minimum Requirements:
No one shall install a
or his agent.
Date of final approval
House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
septic tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according
Signed:
' Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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