457 Wagner RdZ1
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of ,Bedrooms f Q /cF. r— Date
This permit is granted to for the i tallati&d ofXsentic tank
at the residence of eJL e W ddress
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name
No of lines width in.
Type of filter material
Minimum Requirements: House Trailer Tank Cap.
Two-bedroom house
Three-bedroom house
Address
Total Length ft.- No. of Sq. Ft.
Total tons used
800 Sq. ft. line 400
Boo 600
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 Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.