111 Cope Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date 100cJ,
This permit is granted to Qm' eov,'(i for the installatlMRC-e-
Building
septic tank
at the residence of c- �- Address Contractor u 1�¢lcvctr S r Address
Septic Tank Specificati ns: Length Width Depth Capacit Gal. 9,9,0
Manufacturer's Name_ Address &All,
No of lines_ width__ ( in. Total Length c?. 05 ft. No. of Sq. Ft. %Do
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom hous 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: Aa__�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.