2352 US Hwy 64 W Lot 5d x a -n !` t
c; r S
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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANS PERMIT
No of Bedrooms _�
This permit is gran•
at the residence of
Building Cc
Septic Tank
Manufacturer's
No of lines_L width
Type of filter material
Minimum Requirements
No one shall install a
Officer or his agent.
Date of final approval
o Ct �F
Date
to for the installatio of a septicank
Address
,Addressome .e/46erk
ons:Length__ Width _Depth Capacity_ Gal.^ 90'
j
IzA14 �s� Address
�.TotYellLength . 2.?aft. Noof Sq. Ft. �oo
Total tons used 3r- Vo
House -Tr lerT ` Tank Cap. 600 Sq. ft. line 400
Two-bedroom house) 800 600
Thrt e -bedroom house 900 900
t
-e---.-tanR i Davie County without a permit from the Health
I hereby certify that thera`f
specifications.
---r Signed:
Sanitarian
tic-te6nnk has.b6en installed according to
Signed: ;�TA411
Septic Tank Contractor
Note:. Make sketch oij disposal system on back of sheet and mail to Health_ Center.,
q° Mockaville. ,
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