P62970 Dalton Rd PC/DAVIE COUNTY HEALTH.DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms Date 4 —,-2y— go
This permit is granted to 66, for the i tallation of a septic tank
at the residence of Addressi 3, �e�,�c/,C L
Building Contractor < < Address .
Septic Tank Specifications: Length Width Depth C,alpacity Gal. 9Y0
Manufacturer's Name Address
No of lines width_t&/in. Total Length ft. Noc of Sq. Ft. O v
Type of filter material a1sL Total tons used S'
Minimum Requirements: House Trailer ""Tank Cap: 800 Sq. ft. line 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: &WA & p
Sept c Tanz Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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