P1270 Hwy 64W Barnhardt Freezor LockerDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms C5? -
Date / o�, — J0
This permit is grant to
for
the installationofa
septic tank
at the residence of ` Q /�'e
y�nlx�r< ? Address r1pe'r, LSC SAY, (4
/�F�(`nr 1t
Building Contractor
Address
Septic Tank Specifications:
Length Width
Depth Capacity
Gal.' c�
Manufacturer's NameLu`r
r���L� ��- l
Address/r,/ypc k c ,.A/, C
No of lines width in. Total Length
ft. No. of Sq. Ft.
Type of filter material -?!K /o
Total tons used
r->1
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
Officer or his agent.
Date of final approval
tank in Davie County without a permit from the Health
Signed:
Sanitarian
I hereby certify that the above septic tank has been ins�alled according to
specifications.
-:�
Signed• _O Jt �2_l �? t,-�---
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.