1210-1220 Beauchamp RdQeg� s
DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms�l r��l Date l /
This permit is granted to for the installation of a septic tank
at the residence of L�rne.rT� i <4 , ;i Address
Building Contractor Addres�s
Septic Tank Specifications: Length_ gl- y�- Widti�"gepth7,F)Capacity /() Gal.
Manufacturer's Name � ?CC46 1 co 4 Address
No of lines_ width in. Total Length CSO ft. N
Type of filter material /0 /0, . Total
Minimum Requirements: House Trailer Tank Cap. 800
Two --bedroom house 800
Three-bedroom house 900
. of Sq. Ft. 200
tons used 473 7D N S
Sq. ft. line x+00
600
900
No 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 accordin to
specifications.
Signed: d'
4r.
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.