P71671DAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms - Date %/„
This permit is granted toF166. for the installation of a septic tank
at the residence of (-.> Address
Building Contractor.Qov" Ad dress
Septic Tank Specifications: Length Width Depth Capacity Gal. lh�
Manufacturer's Name Address ��+/f
No of lines width in. Total Length o2S ft. No. of '&q.' Ft. bZc
—� i .�_
Type of filter material D Total tons used30
Minimum Requirements: House Tr ler 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 insta led acco ing to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.