492 Main Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms 3 Date-�.—L-,/
`."hi permit is granted to�zyw.,� c2�.t �� for the installation of a septic tank__
xL the residence of Address
Building Contractor ` ' Address
Septic Tank Specifications: Yngth Width Depth Capacity Gal. .sL
Manufacturer's Name -��_ Address
Ido. of lines�CP-11width in. Total Length 6- ft. L?o. of Sq. Ft. vo
Tjpe of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
wo-bedroom house 800 600
Three- edroom house 900 900
1
No one shall install a septic in avie County without a permit from the Health Officer
or his agent. 11
Date of final approval `•f. Signed:
Sanitarian
hereby certify that the above septic tank has been installed according to specifications.
l;
Signed: A�-A�� j�' `Y�,j(e -
Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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