P120169 Pine Ridge Rd P;gyve-Rid,�e0..
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date —6
This permit is grant4d to ,%,eb.� for the installation of �a septic tank
at the residence ofAddress 2
Building Contractor �F�;` Address
Septic Tank Specifications: Length Width Depth Capaacity Gal. 6z)
Manufacturer's Name � � -P .T, ��� ' Address /� �f ���z,
� uD
No of lines_ widthin. Total Len�grtha i �—ft. No. of /Sq. Ft.
Type of filter material .z i o Total tons used ,70
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two--bedroom houst 800 600
Three-bedroom house 900 x`90 '
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: Po- W
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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