P5471 Deadmon Rd b��ineN ped
DAVIE COUNTY HEALTH DEPARTPfENT SEPTIC TANK PERMIT
No of Bedrooms 13. Date A'y !e' /Y ?/
This permit is granted to, 74vle LL,�'o for the installation of a epti
at the residence of Address ,�edr►,,,,,�d.
Building Contractor k�r f,X a- �{,►r r:hr Addresses c lf"S
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 0�
Manufacturer's Name , Z)a-.&4 LZ, Address ZLJ
No of lines. I width +19'in. Total Length ft. No. of Sq. Ft. j d o
Type of filter material Total tons used 13/
Minimum Requirements: House Tra' er 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:
a;6W,�'-
S ptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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