P9971DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No. of Bedrooms
Date C�i�
Tis permit is grant o
zz-. for the iDstgllat
n of a
_
se is t
at the residence of
� ddress
-�
Building Contractor
Address
Septic Tank Specifications: Length
Width Depth Capacity
Gal. Zd-rah
Manufacturer's Name p !�
Address
No of lines width in. Total
Length n aft. No. of
Sq. t.
p
Type of filter material
Total tons
used
Minimum Requirements: House Trail
Tank Gaps 800
Sq. ft.
line 400
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. %
r
Signed:
Septic TyL Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.