2388 Liberty Church Rd (2)L t b r 6 <119 �Kr ch ev,
DAVIE COUNTY HEALTH DEPARUIENT SEPTIC TANK PERMIT
No of Bedrooms �0 ir`�2 � �e r' Date g
This permit is granted to yta K for the installation of a septic tank
at the residence of g 4 /f AddressA7 c�s�ur�%P
Building Contractor Address
Septic Tank Specifications//: Length Width Depth Capacity Gal. 70-oManufacturer's Name g og 4f Address' 3 Ge x""T 7�0H
No of lines_I width__"in. Total Length 47dn ft. No. of Sq. Ft. 1-60
Type of filter material 6 In 4_ Total tons used d of
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two --bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic
Officer or his agent.
Date of final approval
above septic tank has been
I hereby certify that the
specifications.
tank in Davie County without a permit from the Health
Signed:
Signed:
Sanitarian
ins led acco in
Septic Ta Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.