P113066 Buck Seaford RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERiMIT
of Bedrooms Date 3 0 �✓c cl G• !r
f.pis permit is granted to io S '—,-C .r.'i✓ for the installation of a septic tank__
at the residence of U V-% . . c Address�6c
:wilding Contractor "? d(-,\ -e Address SAin {'
Septic Tank Specifications: Length21 Width_�& _Depth Capacity
Manufacturer's Name 1�� ✓� �' 7! s C Address �Ite�P/, n�
No.. of lines _width0in. Total Length �- 2- 5 -ft. Teo. of Sq. Ft. T o C-)
5y -pe of filter material Total tons used 3
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without
or his agent.
Date of final approval
a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
s -1
Signed: �✓P%U' %�1�`'�'` rr``�
hL Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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