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DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms ` _ Date
This permit is granted to <T, for the installatio of a eptic tank
at the residence ofAddress
Building,Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's NameT ,_ Address
No of lines / width in. Total Length,e�ZM ft. No. of Sq. Ft. eZ
Type of filter material Total tons used /p'7
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 pgrmit 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. /3,0zl< fG�
Septfc Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.