P92471 HeplerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date
j This permit is granted to/ for the ins allati of a epi tic tank
at the residence of -7e-.W e p f' Address
Building Contractor j Address
Septic Tank Specifications: Length Width Depth Capacity Gal.` o
Manufacturer's Name_ Address
No of lines_ width in. Total Length ? 6 Oft. N
Type of filter material ��eit/� Total
Minimum Requirements: House Tre r Tank Cap. 800
Two-bedroom house- 800
Three-bedroom house 900
. of Sq. Ft. 6 "5 o
tons used 073
Sq. ft. line 400
600
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: 0,
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and.mail to Health Center,
Mocksville.
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