P102771 Main Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms �3 Date �� o�
This permit is grante to ,� rfor the 'nstallati n ofse tic t
at the residence of Addresst/,k i� z
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. D
Manufacturer's Name ,C i7, ��� i Address
No of lines_ width in. Total Length c?oRdft. No. of Sq. Ft. d n
Type of filter material Total tons used 2e
Minimum Requirements: _House TrailerTankCap. 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: e60011
Sep is Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.