210 Main Church Rd (2)DAVIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms Date s� •S
This permit is gran ed to for the installation of a se tic �ank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. G
Manufacturer's Name- Address '` _
No of lines_ width in. Total Length ft. No. of Sq.(F L
Type of filter material Total tons used 7-5
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:
I hereby certify that the above septic tank has been
specifications.
Signed:
Sanitarian
installed according tb)
1�
/Septic-1fanContractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.