P2267 McCullough RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
1o. of Bedrooms Date
'his permit is granted to ,2aa�%�( xl?- . for the installation /of a septic tank__
at the residence of Address f 7' �,� ✓J _
Bui-Iding Contractor Address �%�✓a�r.�c�
Septic Tank Specification - Length Width Depth Capacity Gal. 960
AkanufacturerIs Name Address l
Ne. of lines o2 width in. Total Length V,5 ft. I:?o. of Sq. Ft. Amo
Type of filter material + *14� Total tons used 17,Z CIO
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
Three-bedroom house 00 900
No one shall install a eptic tank in Davie
or his agent. ,Vot cSE' er )
Date of final approval ✓✓
County without a permit
Signed:
from the Health Officer
Sanitarian
I hereby r_ertify that the above septic tank has been installed according to specifications.
Signed :9
r�J C��-
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
Vl O-. � ;j