776 Bear Creek Church Rd DAVIE COUNTY HEALTH DLPIaT MT
SEPTIC TANK PM-1IT
J 102
No. of Dedrooins V 3 Date V `v , 196 -S
This permit is granted toItat,210S.Q.4 6b for the installation of
a Septic Tank at the residence of d cS�o Ina►1..Addres'Q�- C wy- Po';
Duilding Contractor "'ncy-, A LO S Address 2/6 &adocu
Septic Tank Specifications; Length 'Tidth4' DepthCapacitygoGal, V
IZanufacturerl s Namer1001w, -a WV�ddress � 1'ol�it�.�-
�t
No. of lines Width in. Total length �s � Ft. No. of Sq.Ft.,� ��sa
Type of filter material -4L ROCL�- Total tons used
YL,nina.m Requirements: Tank Capacity Square Ft. of Line
House Trailer, 800 100
Two-Bedroom House 800 600
Three-Dedr6cm House 900 900
No one shall install a septic tank in Davie County without a permit from the
Health Officer or his agent.
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Date of final Approval Signed;
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
AeVt cc Signed eptic k o tractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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d US