219 Ben Anderson Rd (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms _o Date/1'
This permit is granted to ,Lcl��+�ev r, for the install on of a s tic tank
at the residence of f-- Address A41s `
Building Contractor Address
Septic Tank Specifications- Length Width Depth Capacity Gal.__
Manufacturer's Name Address��sl�r
No of lines[_ width_2�Ai . Total Length /ooft No. of Sq. Ft. D®
Type of filter materi Total tons used
se railer �TankCap*. Minimum Requirements: Hou800 Sq. ft. line 400
Two --bedroom house, 800 - - 600
Three-bedroom house 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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: + f
tic TZ&Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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