1174 Liberty Church Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms �j Date 61
This permit is granted to7(!4for the installation of septic t
at the residence of W crz.Addres i
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 dD
Manufacturer's Name Address_
No of lines_ width_"inV Total Length j/3 Sft. No. of Sq. F't_.]o
a.3
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap4�03
Sq. ft. line 00
Two-bedroom house- 0
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.
Signed:
Septic- 76ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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