P102364 Hwy 64E DAVIE COUNTY HEALTH DEPARTiIENT
SEPTIC TANK PEI 1T
No. of Bedrooms Date1
Thi- permit is granted to for the installation
of a Septic Tank at; the residence of C-dyqAddress �� e e
Building Contractor - O ��, �,.5 .P �7� Address r
Septic Tank Specifications: Length Width Depth Capacity 200 Gala
14IanufacturerI s Namey �' 'SPIJ �¢�/�( �a_ Address.---- _
No. of lines tiYdidtht in. Total length ft. No. of Sq.Ft.,e O c, - -
Type of filter material Sz a,.KP Total tons used c7.21
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 LN00 1
Two-Bedroom House £300 600
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 approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed ac.-ording to
specifications.
Signed r �z_�_�
Sep-,ic Tali Contractor
Note: AZake sketch of disposal system on back of sheet and-mail to the Health
Center in Mocksville.
t
AO
1