860 Williams RdDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedroomsrc ` � Date /6 -- 2/
This permit is granted to H4s,6p, 6Z ll`s ^_for the installation of a septic tank "
at the residence ofo ie r o Address ��,�_ Q,z
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width n. Total Length ft. No. of Sq. Ft. ey d�
Type of filter material Pym Total tons used /
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft.•line 1+00
Two-bedroom hous c 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie
Officer or his agent.
Date of final approval
County without a permit from the Health
Signed:
_.__.Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: (,C-�..t.��-,�+�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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