P771 Jolley Rde
DAVIE COUNTY HEALTH DEPARVENT SEPTIC TANK PERMIT
No of Bedrooms C�
Date
? /
This permit is granted to
for the installafion.,at
a septic tank
at the residence of,, -:P/
Address
Building Contractor
Address
Septic Tank Specification Length
Width Depth Capacity
Gal. �F a -b
Manufacturer's Name
Address—
ddressNo
Noof lines_ width in. Total
Length /S -D ft. No. of
Sq.
Ft. 6�+
Type of filter material �` /,Q g;Z&g&d:�z
Total tons
used
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:
Se t c Tank tractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.