265 Feed Mill Rd1
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
"o. of Bedrooms 1,31 Date 3
'_pais permit is granted to 8 r for the installation of a septic tank-
at the residence of 0, )e Addressx-7,e,,
Building Contractor Address
Serotic Tank Specifications: Length WidthW Depth Capacity.____ Gal. dz!
Manufacturer's Name Address /119. 2 U'
No. of lines 62 width 3 in. Total Length ft. No. of Sq. Ft. y o o _
Type of filter material cL Total tons used
Minim= Requirements: House Traile Tank Cap. 800 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: _
S ptic Ink Contracto-
Note: Make sketb''l of disposal system on back of sheet and mail to Health Center, Mocksvi lle.