375 Gladstone RdDAVIE COUNTY -HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms ` Date 2 -
This
This permit is kranted to ` for the installat' n of a deptic tank
at the residence, of Address /�1,
Building Contractor Address
Septic Tank Specifications: Length �5-%Width / epth Capacity Gal. j C�
Manufacturer's Name Address
No of lines width in-. Total Length ft. No. of Sq. Ft. ft-,�`O
Type of filter material Total tons used /2
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.
Signed: Com,
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.