P52065 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
SEPT C TANK PERMIT
Ir„ of Bedrooms iZ Date Ii/c2.., P- D /"L)
pex—,dt is granted to for the installation of K s�e�>ptic ts._-
at the residence of � /� , %� ��` S � �r . � Adaress
Buil-ding Contractor ��. _ Address z , C
Septic Tank Specification Lengthwidth— Depth Capacity Gal, Gy
L,cturer's Name �a'L. P t5' , ' . Address
Ito; of lines�4�idth ''�in. Total Length ,�?e?Sft. i'o. of Sq. Ft. �� 6
T; pe of t filter material ,L� io _ � .yu� ����,+ Total tons used 30 rr�
141nizaum Requirements: House Trailer. Tank Cap. 800 Sq. ft. line 4-00
Two-bedroom house 800 600
Three-bedroom house 900 900
o one shall install a septic tank in Davie County without a permit from the Health Officer
or hi.s agent.
ate of final approval Signed:
Sanitarian
1 hereby certify that the above septic tank has been installed according
%to specifications.
Signed:
Septic Tank Contractor
Note- Make sketbs^ of disposal system on back of sheet and rail to Health Center, Mocksvi..le.