248 Liberty Church Rd (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date/'—
rhis permit is granted to �cJ ' moi_ for the installation of a septic tank__
at, the residence of Address
Building Contractor Address
Septi.c Tank Specifications: Length Width Depth Capacity Gah>
Manufacturer's Name Z _ _ Address
Net of lines widthi . Total Length 00ft. ';o. of q. Ft. 2'O
Type of filter material �3�Z�1JLc,_ Total tons used if
M.-;'..n4=um Requirements: House Trai er�uSqTank Cap. a00 ft line x+0o-bedroom ho00 600
Three-bedroom house 900 500
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval % —,3 / � � �% Signed:i7��
T9�11Sanitarian
I hereby certify that the above septic tank has been inst d according to specifications.
Signed:-eoll
Septic Tank Cont etor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville,
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