755 Hwy 801SDAVIE COUNTY HEALTH DEPAR LENT SEPTIC TANK PERMIT
No of Bedrooms Date 90-x(�, az
This permit is granted to AS A (for the installatio of a s ptic tank
at the residence o Address
Building Contractor Address Pic -
Septic Tank Specifi tions: Length Width Depth Capacity Gal. 8l�
Manufacturer's Name r �// / / ress_
No of lines_ width in. Total Length � -5ft. No.
of Sq. Ft. 1�1 D a
Type of filter material Total tons used 29-30
Minimum Requirements: House Tr ler Tank Cap. 800 Sq. ft. line 400
Two --bedroom house 800 600
Three-bedroom house 900 goo
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 Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.