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DAVIE COUNTY HEALTH DEPARTIMT SEPTIC TANK PERMIT
No of Bedrooms Date — /Co — o
This permit is granted to for the installat'on of a septic tank
at the residence ofr a Address, yc� K c P
Building Contracto d,5 Y` Address
Septic Tank Specifications: Lenith Width Depth Capacity Gal. 2,n o
Manufacturer's Name Address P71
No of lines_ width
2k i . Total Length 3rst1 ft. No! of q. Ft.
Type of filter materialTotal tons used
Minimum Requirements: House Trailer 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 inst led acco Ig t
specifications.
Signed:
Septic Tank ontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
Ali D
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