P123071 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms- Date /(R-- -?,o -- L
This permit is granted to for the Inst lation of a septic tank
at the residence of Address ,7
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity _ Gal. ep
Manufacturer's Name Address 4 1i�
No of lines` tridth_, (in P Total Length /O ft. No. of Sq. Ft.
Type of filter material 7t?"io o� Total tons used
Minimum Requirements: House Trailer//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:
Septic retractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.