P42971 EdwardsDAVIE COUNTY HEALTH DEPARVIENT 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
Building Contractor AUQ-V � Address
Septic Tank Specifications: Length -Width Depth Capacity Gal. 90 A
Manufacturer's Name Address
No of lines width in. Total Length ft.' No. of Sq. Ft.
Type of filter material
Minimum Requirements: House Trailer
Two --bedroom house
Three-bedroom house
Tank Cap.
Total tons used
800 Sq. ft. line 400
Boo 600
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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