700 Hwy 801N (2) dl
DAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms Date �-
This permit is granted to g! s S ,7-.,S i "c for the installation f a se tic tank
at the residence of/Y�¢c4.4(z Mom✓.`.:K CTf���d ress-RiesanQ aC IL H e p
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. Zz>o
Manufacturer's Name �h E>' .� Address 3 1�__
No of lines_ 3 widths in. Total Length 30bft. No. of Sq. F o
Type of filter material Xe,,,o Total tons used .3/
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two--bedroom house 800 600
Three-bedroom house � "
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. �- �) / _
Sigrfed: daaAr►, a&—to,� /.
\ Septic Ta ontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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