859 Junction Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
o, of Bedrooms Date
Phis permit is granted to /3. ��-� for the installation of a septic tanb,
e ; �thE- residence of : S� L c,,l vu+! _Address 42.�.,�,.
Burl iir.- Contractor ,-�s':��, - `=-G -=...� Address
5e•i-)t.Tank Specifications: Length Wth� _Depth Capacity
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Manufacturer's Name /l Leo _ Address 2�
Ito: 01' line: /�width�in. Total Length ,�ft. R'o. of Sq. Ft. o
,�-pe of filter material Total tons used ZZ
i:1.ni hn :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 tank in Davie County without a permit from the Health Officer
or bis agent.
D#:e of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed: _
Septic .A Contractor
Note: Make sketu' of disposal system on back of sheet and mail to Health Center, Mocksville.
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