1366 Sheffield Rdof Ledrooms �.
DAVIE COUNTf HEALTH DEPA`MKIENT
SEPTIC TANK PMEIT
Date,
permit is granted to __>>��_•- for the installation
of ept is Tank at the residence of ���Address
3u:!_7_di nr; Contractor r'�?!L �! Address
Tank Specifications: Length _ tv,:idth _ Depth__ Capacity / yz Cal
tlaru_factu •orr s Name .z <: :� % u- --Address
P;:o, of li!,.(:s , j.;idth -�e�/in. Total length _-_-- _),� i ft, No. of �Sa.,I-t.5�cz
yl� olT4:1-11,11".
' filter material Total tons -used !e,�G:of
I,.i.n_im,m. PeoLi _rements• Tank Capacity Square Fc. of Lire
House Trailer &CO L�00
Ttro-Bedroom House 800 600
`_Ir ec Bedroom House 900 900
Uo orae shall install a septic tank in Da,,rie County without a parmi.t frolr,.the
Ilea.-_th Officer or his agent.
Date of final approtlal Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed acoordi_ng to
specifications,
Signed _
Septic Tank Contractor
N ote: I -lake sketch of disposal system on back of sheet and mail to the health.
Center in Iiocksville.
LL1� �.t:� l�
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