143 Spruce StDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms -? Date /� -
This permit is granted to G m o rL for the installation of a septic tank
at the residence of 72 os s4%4 S,22,2zan Address
Building Contractor G c �y 4s�n� I Address
Septic Tank Specifications: Length Width Depth /capacity_ Gal.^Fa o
Manufacturer's Names — _ _ Address
No of lines 2Z width i Total Length C2 on ft. No . of q. Ft . �� 0,0
Type of filter material *lo St�Total tons used ?3;a
Minimum Requirements: House TraileW 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 ins; Sed acc o ding to
specifications.
Signed:
Septic TaA Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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