186 McClamrock Rd (2) DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Uo. of Bedrooms . 3 Date /a X070 �G
This permit is/ granted to , for the installation of a septic tanks_.
;;,t the residcncei'of to P Address d/Qt-n
BuildingContractor �� '
c�,�.s1-�z_ Address ��� �
Septic Tank Specification : Length Width r Depth Capacity�Gal. t' n(_
Manufacturer's Name Address
Ido. of lines--L width -3 in. Total Length ft. Pio. of Sq. F�/
Type of filter material Total tons used
i.i.nimt�l Requirements: House Tr filer Tank Cap. £300 Sq. ft. line 1+00
Two-bedroom house 800 600
Three-bedroom house 900 f: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 /-2 6 Signed: fC �__,« _
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:7Y C- L r rr� ry I.c"
�y�Se0tgy nk ractor
�.
Note: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksviile.
rw
Yo