2165 Davie Academy Rd (2) DAVIE COUNTY HEALTH DEPARTMENIT SEPTIC TANK PERMIT
igo, of Bedrooms Date -
rhis permit is granted to for the installation of a septic tank-
x1. the residence of C�� _ Address
Building Contractor Address /j�f .;f "
Septic Tank Specifications: LengthWidthWidthw Depth Capacity Gal, 9,_^
Manufa:;turerI s Name u:t! , 7, �o Address
No. of lines— width__ kin. Total Length 13S ft. No.. of Sq. Ft. _ eV6
L __
pe of filter material Total tons used
2,lini,miun Requirements: Hous railer Tank Cap. 800 Sq. ft. line 100
Two-bedroom house 800 600
Three-bedroom house 900 900
No one gall install a septic tank in Davie County without a permit fro the Health Officer
ox- his agent. I
Date of final approval y'/x,47 Signed: _
t Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:. � C M
/� �eptihanik Contractor
Note: Make sketbk, of disposal system on back of sheet and mail to Health Center, Mocksville�
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