P111971 Deadmon Rd #1 )l.edilwa a/ .
DAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date
This permit is granted to<,-Nz4, p Sfor the installation of aseptic tank
at the residence of Address
C
Building Contractor Address � ��i C
Septic Tank Specification : Length Width Depth Capacity Gal. gm
Manufacturer's NameZ/5A,,Zp Address_ g 2VR_C�
No of lines_ width in. Total Lengthh _g2gSSft. No of Sq. Ft. 4 o d
Type of filter material o gamaax Total tons used ,a 3 a
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two--bedroom house 800 600
Three-bedroom horse 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:
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
P
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