P10566 Jerusalem AveDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
':�, of Bedrooms
Date
':his permit is granted to DA0 p .4 �eZ /7, 4(/i� a. for the
installation of a
septic tank_
st the residence of
Address
Building Contractor, �i�,'// oh,g,✓
Address e7
-y T"" wec -1�
_
Septic Tank Specifications: Length Width,
Depth
Capacity Gal.
o a
P anufacturer's Name %/rt p
Address
�i4/n "P
No, of lines width_L_y in. Total Length / 5 o ft. Eo.
of Sq. Ft. c)
C .
a., e of filter material7 % t 1lP
Total tons
used I -A/
_
Minimum Requirements: House Trailer Tank
Cap. 800
Sq. ft. line
1+00
Two-bedroom house
800
600
Three-bedroom house
900
900
Pio one shall_ install a
or his agent..
Date of final approval
septic tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
hereby certify that the above septic tank has been J.nstalled according to specifications.
Signed:
--ff--je Septic Tank Contractor
Note: Make sketc.i of disposal system on back of sheet and mail to Health Center, Mocksville.
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