1693 Hwy 64W (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERiMIT
lF'D.: of Bedrooms Date/ - L Y - (, 2
11is permit is granted to sz;:. �, �Lr. �� for the installation of a septic tank-_
x�. the residence of Address
Building Contractor �%', �_a,�.e Address P-"; (1,
`;.
Septic Tank Specifications: Length Width Depth Capacity G�1.
Maj:ufacturerIs Name Address � 'c
Ido.. of lines width !/< in. Total Length ft. No. of Sq. Ft.
Tie of filter material Total tons used /3• .�
v
,.4!nimtua Requirements: House Trailer Tank Cap. 800 Sq. ft. line I+00
Two-bedroom house 800 6600 -
Three -bedroom
Three-bedroom house 900 900
No one shall install a septic tank in Davie County wit2rou permit from the Health Officer
or his agent.
Date of final approval /- �7 " - �� Signed:
Sanitarian
1 hereby certify that the above septic tank has been installed according )o specifications.
Signed:
Septic Tank Contractor
:Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksvilleo
r
(77