P12169 Hwy 601SIts P -w q &0/ -S,
DAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date
This permit is granted towC' for the install tion of�a peptic tank
at the residence of / Address 6����
Building ContractorAddress
Septic Tank Specifications: Length Width - Dep Capacity Gal.
Manufacturer's Name �G�c %, �. Address A21B�C�
No of lines` width_ in. Total Length ft. No. of q. Ft.
Type of filter material #/ eLZ&gAdig - rciL� Total tons used
Minimum Requirements: House Trailer/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. Q
Signed: •�ir�. ��% � .
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
71
. , .;i
V��;i :1:`...� ..;�' ')� r;�l: �`r;.� .�fE..�_ r � 'rr' UC;%x .:.t7! ... .._:.°•:]�1�3 ::.T...Y.4:•x
Cr,t?j r r.
16 :.
r_.. ..:ii :'rru� 1"C)r_� u_.1 `a ....�i va. '✓ia ... �y..�: i.Ji. _.i:w. rJ _ :/CR •- t•v�". i f�.,.�i,; ,.. r.�. .:. .i{ �)l•1
�" ;j
,� ...•1J `Il �.� tom.-��^Jy �.. 1.��_1 �._L...- ._1.. _. J :(1 r3 �'L� rn... ry `. i.�l. rry •,J 1� ._ v..j� -...
_