P101471 No Creek RdDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms ; /e y— Date�it
This permit is granted to TiL°o . for the installation of septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal..
Manufacturer's Name 6 s�' - Address�� j
No of linesL width in. Total Length oo ft. No. of Sq. Ft. .±�2 0
Type of filter material -,alp Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line I+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 beenins alled according to
specifications.
Signed: �
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.