P1963 Hwy 901WDAVIE COUNTY H PALTH DEPSaTMT
SEPTIC TANK PL—d-aT
No. of Dedrooms 3 Date
This permit is granted to D LP SP�i/ :e _ `> y„i �' �o for the installation of
a Septic Tank at the residence of 1(�` �/ P� Address i('oe kSyi/ e,11/•e,
Duilding Contractor Address
Septic Tank Specifications: Length 77L'uidth. �A L Depth 6A,► Capacity c) Gal.
Manuf acturer t s Name _7A u; c� Sr�-i / I C " / e2 f' � u Address .� ,�` 1 0 T /4 0
No. of lines _Width in. Total lengthFt. No. of Sq.Pt. 90 n
Type of filter material '7�.� F — L �` / P Total tons used %L
T,iinir wa Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
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.
Signed
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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