204 Mocks Church Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms C C� � le c' Date
Thi:, permit is granted to�! �bc� lc` S for the instal I at"ioZ instalof a septic ta:_�;
-t the residence of Address ��fi. j, loci K �e
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacit___Pal. � a�_
:Manufacturer's Name 4- � Address 11 1
T?o, of lines_ width 3 in. Total Length _13�1 ft. -No. of Sq. Ft.
v— of filter material62aV%r-4 C Total tons used j q I
1111n.imum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No o4e 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 to specifications.
Signed:
Septic Tank Contractor
date: Make sketbh of disposal system on back_ of sheet and mail to Health Center, MocksvilleG
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