P11971 Williams RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms # Date A40 ! /7,7/
This permit is granted to for the installation of septic tank
at the residence of %L2� � Address
Building Contractor ol.. Address
Septic Tank Specifications: Length Width Depth Capacity Gal./ 6-z'tb
Manufacturer's Name
;Address%3
No of lines_, width_! in. Total Length c2ibNo. of Sq. F . (o L
Type of filter material v Total tons used to
Minimum Requirements: House Trailer
Tank Cap. 800 Sq. ft. line
Two --bedroom ouse 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.