P62064 Cornatzer Rd DAVIE COUNTY HEALTH DEPART11ENT
SEPTIC TANK PIMaT
No. of Bedrooms Date �jz_ �-a This permit is granted to A -�� L for the installation of
a Septic Tank at the residence of 6: � v Address
Building Contractor Address
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Septic Tank Specifications: Length Width s2', Depth q' Capacity DD Gal.
Manuf acturer Is Name_ , �- Address,
No. of lines 11idthin. Total-length 300 Ft. No. of Sq.Ft. 100
Type of filter material Total tons used 3 U
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
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 EZ& Jtft�lajAet��,-
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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