P6370 McKnight RdDAYIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms
Date
This permit is granted to for the ins alla i n of a septic tank
at the residence of�i-s k.cnK Address �-f?A.1 Xw zy�
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 00
Manufacturer's Name a?/ Address
No of lines_ width Z3 . n. Total Length . roc ft. • No. of Sq. F d 6
Type of filter materialTotal 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 Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.