P81969 Angell RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
,:o. of Bedrooms „ 1 Date � - � -
'_':his permit is granted to �, �',." . 0_� for the i.stallation of a septic tank _
at the residence of Zss-;e F E_41on Address Nock V , `1111e,lv,i
Building Contractor', �,ct-r,� Address
Septic Tank Specifications: Length Width Depth Ca ac Gal. lyoo _
Manufacturer's Name �Be�-- Address
Iic� of lines width in. Total Length I Fb ft. No, of S . Ff t G a -a
a'ype of filter material S Total tons used
Minimum Requirements: House Trailer Tank Cap. £300 Sq. ft. line 400
Two-bedroom house 600
Three-bedroom house 900 900
Pio one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent
Date of final approval
Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Se is Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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