218 Dyson Rd (2)V
DAVIE COUNTY HEALTH DEPART14ENT SEPTIC TANK PERMIT
No of Bedrooms .13 9�,ze�
Date %i0
This permit is grant to for the i all ion• f a s ptic tank
at the residence of Address
Building Contractom= Address
Septic Tank Specifications: Length Width Depth Capacity Gal.46 o 0
Manufacturer's Name a���,�,`� Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total
Minimum Requirements: House Trailer Tank Cap. 800
Two --bedroom house- 800
Three-bedroom house 900
tons used
Sq. ft. line 1+00
600
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.