P83068 Liberty Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
-o„ of Bedrooms Date 3 0
"hio permit is granted to _ �/ for the installation of a septic tank..
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity��
Manufacturer's Name Address
11 of lines width in. Total Length _ ft. o. of Sq. Ft. cra
__._�
Type of filter material Total tons used
l4J-ni:aum Requirements: House Trail r Tank Cap. 800 Sq. ft. line 100
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
hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketb'z of disposal system on back of sheet and mail to Health Center, Mocksville.