4844 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms .2 Date !�- /6 ) 0
This permit is granted to for the installatio of a septic tank
at the residence of -,I- Address �'-
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 69
Manufacturer's Name Address /v.,( `�
No of lines' width W i Total Length 3 d� ft . No . of S Ft/
Type of filter material io n Total tons used .3u
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: _
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.