P121869 Dulin RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date %,�? —/ L. l
Q//Jr.
This permit is granted to [ t,t for the installation of a septic tank
at the residence of e &Cring rt ,T�• Address A34.3 4j�c� ,I�s%,� f
Building Contractor Address
Septic Tank Specifications:- Length Width Depth Capacity Gal. L -1,-)L-1,-)7
_
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Manufacturer's Name1�� Address ��
No of lines \3 width _,.&, i�� Total Length 3 De-, ft. No. of Sq. Ft. ' >er�
Type of filter material Total tons used 4ISf
Minimum Requirements: House Traile Tank Cap. 800 Sq. ft. line 400
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. L,
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Signed: / c��' r—, e�C-L
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.