P101660 Liberty Church Rd DAVIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms Date /0 --Af= O
This permit is granteA to for the installation of a septic,t
at the residence of ,�- ��,� Address S
Building Contractor s-azst Address
Septic Tank Specifications: Length Width Depth Capacity Gal. a
Manufacturer's Name Z -c Address
No of lines ? width--,U in. Total Length nft. No. of Sq. Ft. Ye o
Type of filter material Total tons used
Minimum Requirements: House Trailer -- Tan'. Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
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 approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. '
Signed: '
i �i
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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