173 County Line RdDAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted tofor the installation of a septic tank
at the residence of 0 h Address
Building Contractor
Septic Tank Specifications: L//9en Width Depth Capacity Gael / 00 0
Manufacturer's Name,�7�aC,Le�=w��s ' Addres - -�
No of lines ,width in. Total Length / O ft. No. of Sq. it. 6 0d
.-�
Type of filter material ��- -Total tons used
Minimum Requirements: Houser Tank Cap q 800 S . ft. line 1+00
q
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 hasbeen installed according to
specifications.
Signed* O _
S is Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to,Health Center,
Mocksville.