P82778 Hwy 158 DAVIE_COUNTY_HEALTH-DEPARTMENT'- _SEPTIC_TANK_PERMIT
No.of Bedrooms ( �Ck k �-s - Date KJOV &
This permit is granted to -ftfor he,installao of a septic tank
at the residence of r;c,md LZ- A res A11 Address
GontYWtor _,�/^inn ^c�(c� �'ct r�-c Address
Septic Tank Specifications: 'Length Width Dep h Capacity Gal. 900
Manufacturer's Name t Address-�
No of lines_ width_Uin.. ._Tot6.1 Length 4L it. No. of Sq. Ft/' 4(O�S�
Type of filter material. Total tons used I1LlL
Minimum Requirements:_ House Tr 'ler Tank Cap. 800 Sq. ft. line 400
__ r Two-bedroom house 800 600
Three-bedroom house 900 900
No one. shall..install' a septic tankin Davie County without a permit from the Health
Officer' or his agent.
Date of final approval 1 ! Signed:
+Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
t Signed: Wa.4
Septic TanIkzCont6Ktor
Note: Make sketch of disposal system-on back of sheet and mail to Health Center,
Mocksville.` rrS
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