P62370 Williams Rd DAYIE COUNTY HEALTH DEPARTIUM SEPTIC TANK P T
No of Bedrooms Date
This permit is granted to w , _ is for the installation. o a septic tank
at the residence .of .Address
Building Contractor AiZ�j_ - Address
Septic Tank Specifications-/
pecifications: Length Width Depth : Capacity Gal. yam
Manufacturer's Name Address
No of lines 3 width Total Length ft. No. of q. FIC.
Type of filter material Total tons used • 3/
Minimum Requirements: House Trailer Tank Cap. 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: dL:Zr7_
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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