113 Bethlehem Rd (5)DA`JIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms Date � �Y 0 t! �o
This permit is granted /to P -*f/l1for ,the ins llati on of a septic tank
at the residence of > oR 5,01e Address
Building Contractor E/,P,Q% Address
Septic Tank Specifications: Length Width Depth. Capacity Gal. �o
Manufacturer' s Name IJP L): e- ci A-✓� Address
No of lines_ width__U in. Total Length aid S ft.. No. of Sq. Ft. 0 0
Type of filter material 'S -7-o Al -,-' Total tons used 33
Minimum Requirements: House Trailer 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 �o
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.