P111769 McCullough RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date _ jl
This permit is granted to &&fh o►� /f�� for the installation -Of a septic tank
at the residence of : ccl ,1� �' `-cf� ; e Address 6 o /s
Building Contractor e- Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name CAddress
No of lines_ width j �n. Total Length Q20,Qft. No. of Sq" ' t. 6,00
Type of filter material ELe-1 � Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 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 ,�%�. c{`Signed:.
—� aitarian
I hereby certify that the above septic tank has been installed according to
specifications. ��-
Signed:
Septic T nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.