P62866 Country LaneNo. Bedrooms
DAVIE COUNTY HEALTIi DEPARTMENT
SEPTIC TANK P=jiIT
Date w> `% !.--%
This permit is granted to for the installation
of a Septic Tank at the residence of 1)1 �Z,._ Address
BuildingContrat m.. a� /�1�r`Li1 .i- Address
Septic Tank Specifications: Length tididth Depth Capacity a Gal,
Manufacturer's Namer r..t:z_t� , ► iew' Address (Vsr&_10
No. of lines Jdidth �l in. Total length d ft. No. of Sq.Ft._ 4 cm
Type of filter material Total tons used 3 3 --
Minimum Requirements:
House Trailer
Two -Bedroom House
Three -Bedroom House
Tank Capacity
800
800
900
Square Ft. of Line
100
M.
No one shall instalLa`septic tank. in._Dav e Conty without a perridt from the
Health Officer or his agent.
Date of final appro%ftl Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
r
r
Signed
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the Health
Center in Mocksville.