142 Center Circle Lot 28DAVIE COUNTY HEALTH'DEPART ENT SEPTIC TANK PERMIT
No of Bedrooms
This permit is granted to1nlnoom for t.he-- installhtf;eh-Ar,a septic tank
at the residence of T Address' r
Building Contractor v` rep eAddress Yr s 1 Y,rt, /V i Ce-
Septic Tank Specifications: Le h_ Width Deptk Capac'ity_o Gal. �0
Manufacturer's Name7z l � Cm � � AddressT` C �
No of lines_ width (t in. Total Length eft. ',No. of q. F . l 6DD,!
Type of filter material � �� tai P Total tons used::Z.S
Minimum Requirements: House Trailer Tank-Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house t 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 -2, Signed: ( Clot
Pfinitarian
I hereby certify that the above septic tank has been Inst led acco in to
specifications.'. Signed::
--- --- - .-.: _.._ ----
8eptic'Ta Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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