P51768 Bethel Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
I;o. of Bedrooms Dates
Timis permit is granted to for the installation of a septic tu-!
-qt the residence of 6o 61 Fn Address X('74' `% i �.z:��� �-_ �/; C
Building Contract9�11 � Address 47C,� jai C f
Septic Tank Specificatio Length Width Depth Capacity Gal.
,Manufacturer's Name Address l r� C17Ines width 3 Al-i . Total Length oF� a o
No, of 1 _� � o ft. No. of Sq.
Type of filter material W/O Total tons used .75-7-o-,
Minimum Requirements: House Traile Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 19-0-0-) r7 �
No one shall install a septic tank in Davie County without a permit
or his agent.
Date of final approval Signed:
from the Health Officer
Sanitarian
I hereby certify that the above septic tank has been instpjIled according specifications.
u LSO Signed: -ntra
' / /� _
�1 SeptTank Coctor
Note: Make sketQw of disposal system on back of sheet and mail to Health Center, Mocksville.