P9271 Cana RdDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to for the i tall of a 6e is tank
at
at the residence of ' Address D ,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.240
_
Manufacturer's NameAddress
No of lines` vridth_Zkin. Total Length �Qft. No. of Sq. Ft. S O
Type of filter material_ Total tons used d tS�
Minimum Requirements: House TraJZer Tank Cap. -800 Sq. ft. line 1+00
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 ins lled cor 'ng to
specifications.
Signed:Y
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.