120 River Rd (2)No. of Bedrooms
DAVIE COUNTY HEALTH DEPART1,1ENT
SEPTIC TANK PERIIT
Date, --_
Thi.- permit is granted to for the installation
Of a Septic Tank at the residence of �l ` ess•'�—���r/6t� ('✓.� C f
Building Contractor JO Address
Septic Tank Specifications: Length Width Depth Capacity ad aGa1.o
Manufacturer's Name ��-Y"',CL�//a,t i d • Address Waa§/I
No, of lines Z j,9idth�_in. Total length _��a ft. No. of Sq.Ft.Ga0
Type of filter material 704/D � Total tons used XA ,_45L_ _
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
Two -Bedroom House 800
g
Three -Bedroom House 900 900
No one shall install a septic tank in Davie Countywwithout a permit from the
Health Officer or his agent.
Date of final approbal
d--1 %,6 S-_
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Si
sic Tank Contractor
Note: Hake sketch of disposal system on back of sheet and mail to the Health
Center in Mocksville.
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