214 Evans RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
"o, of Bedrooms f�� Date
T'
permit is granted to for the installation of a septic tank_.
a. the residence of Address es r
Building Contractor Address
Se:ntic Tank Specifications: Length Width Depth Capacity _ Gal.DO
M nufacturer's Name Address _
No. of li nes�widthin. Total Length /SQ ft. iio. of Sq. Ft . 00
Type of filter material (7!;&a- Total tons used
41nimtun Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100
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
hereby certify that the above septic tank has been instal ed according tos ecifications.
Signed:
Septic Tank Contractor
Note: Make sketb. of disposal system on back of sheet and mail to Health Center, Mocksville.
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