P82668 Cherry StDAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT
'to, of Bedrooms, v
Date p'7
'this permit is granted to `b,t�P
for the i`nstallatioifc of a sevtic tank,..
%` �:
�/ 6� � c
at. the residence of ,� � r Iva r rt
_ Address H e r r � 1-7
Duildirg Contractor
Address
Septic Tank Specifications: Length Width
Depth Capacity Gal.
Manufacturer's NameAddress
_
�
�C i
No,. of lines width in. Total Length
ft. No. of Sq. Ft. (�c�
Tt:e of filter material i
Total tons used
Nl n.imum Requirements: House Trail Tank Cap. _800. Sq. ft. line 4OC
Two-bedroom house
_ 800 0
Three-bedroom house
900 goo
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 according specifications.
Signed: 6�jlj)101/4,
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.