P41770 Cornatzer RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date —1%-- � Q
This permit is granted to j/,'s .i.�,,�cn'l�e for the ins allation of a septic tank
at the residence of ��i , �r4 C Address ; , �i'I1
Building Contractor ,Aq,►g e ' Address
Septic Tank Specifications: Length Width Depth Capacity Gal.i
Manufacturer's Name Address AJ4,
No of lines width in. Total Length -ft. No. of Sq.,-Ft./5_
Type of filter material l�ct Total tons used
Minimum Requirements: House Trai] r Tank Cap. 800 Sq. ft. line 1+00
Two --bedroom house 800 600
Three-bedroom house 900 900
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 according to
specifications.
r
Signed:41. a2 ,4
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.