P12965 Cana RdDAVIE COUNTY HEALTH DEPARTt1ENT
SEPTIC TANK PERI•iIT
No. of Bedrooms Date
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This permit is granted to for t4 installation
of a Septic Tank at the residence of �liLy-�. G� ,, Address !iZ oC ,��-
Building Contractor. Address
Septic Tank Specifications: Length Width Depth Capacity Gals
Manufacturer's Name Address
No. of lines Iddth in. Total length ft. No. of Sq.Ft.
Type of filter material Total tons used
Iiinimum Re uirements
I uvv+n
Huse Trailer
Two -Bedroom House
Tank Capacity Square Ft. of Line
&00 100
800 600
Three -Bedroom House 900 :' 900
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No one shall install a septic tank in Davie Countywithout a perritit from the
Health Officer or his agent.
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Date of final approbal /) 1� Signed:
Sanitarian
r
I hereby certify that the above septic tank has been installed according to
specifications.
Signed
Septic Tank Contractor
Note: I -lake sketch of disposal system on back of sheet and mail to the Health
Center in IIocksvilI e.
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