1593 County Home RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
To, of Bedrooms .3 Date 3 I $� e-e
This permit is granted to for the installation of a septic tank;.
at the residence of Address
Building Contractor �� Q .�m Address
Septic Tank Specifications: Length Width Depth Capacity
Manufacturer's Name /Ii1�, ��
',,M��a Address
ITc� of lines c� width in. Total Length ft. No. of Sq. Ft.
Tjpe of filter material TcH� Total tons used % y � iv - z-
T
Minimair Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom houset906- 600
Three-bedroom house G
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Da+e of final approval 3 -/ ' G Signed:
Sanitarian
i hereby certify that the above septic tank has been installed according to specifications.
Signed: a �! '"1�
Septic Tank Contractor
Note: Make sketaa of disposal system on back of sheet and mail to Health Center, Mocksville,
i ,,
� o„o �
-i �J
„l�
�,
� �
�^ � _ °
n
���_'�,
�.
�. _
_�r
s��