P101670 Main Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
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No of Bedrooms 3 Date 1 O
This permit is gran to for the installation of a seRtic ank
at the residence of , Address i(`17 03
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.4060
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total
Minimum Requirements: House Trailer Tank Cap. 800
Two-bedroom house 800
Three-bedroom house 900
tons used
Sq. ft. line 400
600
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 Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.