P866 Hwy 158DAVIE COUNTY/ HEALTH_ DEPARTMENT SEPTIC TANK PERDIIT
!io, of Bedrooms //ta� -Te
("veil 7". 'fie,rSJ Date ug us /% 4
This permit is granted to % e ry /) & dm o n for the installation 6f a septic tank.,
at the residence of 11n70,n _ Address ccs 5 G4/F� ,` PG way
Building Contractor T � Address
Septic Tank Specifications: Length Width._..Depth Capacity Gal.
ManufacturerI s Name �/�4 v �`� % < C� a ~ Address o a�� o r,� e e
I?o; of lines___width ' width_ Total Length Zo o ft. Eo. of Sq. Ft.
T� re of f..i.1-er material /(/y /o ,C7Lo h Total tons used
Requirements: House Trailer Tank Cap. 8� Sq. ft. line 1�0�
Two-bedroom house 800 b0()
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
Late of final approval Signed:
i 1�1/ Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketY-, of disposal system on back of sheet and mail to Health Center, Mocksville„
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