P101069 Hwy 64EDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date /D - / d -6(9
This permit is granted to for the installation of a septic tank
at the residence of _� Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. &C _
Manufacturer's Name ^, ! e- Address 2�
No of lines_width-4/Yin. Total Length o.D ft. No. of Sq. Ft. �o 0
Type of filter material Total tons used /_3
Minimum Requirements: House TraiLdzr 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 installed according to
specifications.
Signed: �Q7iu
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.