P31271 Jerusalem AveDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms—r` � r' Date �� — la_
7 /
This permit is granted tc� / d;P �,%,�'o for the installation of a septic tank
at the residence of G,'_ rsoyc Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. ,� as
Manufacturer's N v; L°o Address /�% sv�_T P
No of lines width in. Total Length foo ft. No. of Sq. Ft. :''
Type of filter materials Total tons used
Minimum Requirements: House Tr8 er Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie
Officer or his agent.
Date of final approval
County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has beenin talled according o
specifications. j �
Signed:" `v fY�
Optic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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