P72267 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
U..-), of Bedrooms 3
Date
_
his permit is granted to e /
for the installation of a septic tans__
at, the residence of `�iac��-Z
Address
^�N,ca;
Building Contractor ����!�tr �C
Address /t
Septic Tank Specifications: Length Width
Depth Capacity Gal.
Manufacturer's Name ZE�- y
Address
Tic. of linesg width 3 6, in. Total Length
3 0 0 ft. No. of Sq. Ft. 9 a d
Type of filter material
Total tons used
_
Minimlua Requirements: House Tra' ler Tank Cap. 800 Sq. ft. line
1+00
Two-bedroom house
800
600
Three-bedroom house
9 0
00
No one shall install a septic tank in Davie County
without a permit from the Health
Officer
or his agent.
Date of final approval a -�� —� %
Signed:
Sanitarian
I hereby certify that the above septic tank has
been installed according to specifications.
Signed: _ Y
Septic Tank Contractor
Note: Make sketb: of disposal system on back of sheet and mail.to Health Center, Mocksville,
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