P111670 Fairfield RdK/aac/
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms i'4 ` le Date If-16
This permit is granted to .i,(F.S for the installation of a, septic tank
at the residence of 4E,,n? e -r W Woo Address /� , '/ i7ia'�
ddress
Septic Tank Specificatio s: Length Width Depth Capacity Gal. Zoo
Manufacturer's Name GJ,,� AddressZ 2f1---2
No of lines,_ widthYein. Total Length eft. No. of Sq. Ft. Y a o
Type of filter material Total tons used /
Minimum Requirements: House Trailer 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.
Signed: �
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.