149 Mocks Church Rd (3)s �- ., .a. r�� r �.� ...
� _�
DA`JIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date 3 -- al — � oZ
This permit is granted to for the installation of a septic tank
at the residence of �� es �I. CLQ Pr_ Address Fal,_
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name
No of lines width
Address
in. Total Length ft. No. of Sq. Ft.
Type of filter material
Minimum Requirements: House Trailer
Two --bedroom house
Three-bedroom house
Tank, Cap.
Total tons used
800 Sq. ft. line 400,
800 600
900 goo
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.