P8569 Hwy 158 Disher Trailer ParkDAVIE COUN HEALTH DEPARTMENT SEPTIC TANK PERMIT
T o, of Bedrooms '3 =r%g � r /a _6
k Date
anis permit is granted to ocrn for the installation of a septic tank .
at th.e residence of` /
Address jd UQ � c <I
Building Contractor _ Address
Septic Tenn Specifications: Length Width y Depth Capacity Gal.. /� d3'0
.Manufacturer's Name �e"-4 ess
No, of lines '_3 width//136 in. Total Length j7) ft. fo. of Sq. Ft. X�sr".
Typ<< of filter material ^t,�J Total tons used -,0
MJ.X1-im.1 Requirements: House Tr ler Tank Cap. 800 Sq. ft. line Y 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 a-;3proval � -� S 6 Signed: < / L1, _ —
Sanitarian
I hereby certif',t that the above septic tank has been ins alled according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbi of disposal system on back of sheet and mail to Health Center, Mocksville.
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