P73070 Mocks Church Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
,tic. of Bedrooms _ Date �-L�O-- �D _
`leis permit is granted to } mac�isx ���S _ for the installation of a septic ta:,k;
at the residence of 2 r7,�-r- Address
Building Contractor CZOof Q Address
Septic Tank Specifications: Length Width Depth Capacity Gal. q cy-b
Manufacturer's Name Address_/ ,3 9�
I?o< of lines^width q in. Total Lengtho Lft No. of Sq. Ft. 9
Type of filter material Total tons used ��O
Minim= Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100
Two-bedroom house 800 600
Three-bedroom house 900 900
Ido 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
r hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketar of disposal system on back of sheet and mail to Health Center, Mocksvilie,:
��c�'s ��i. l�I�d� /�aye
i
-:
Ow
��,�,
o � � �
ocz,
i