P52467 Campbell Rd - B & T Poultryf- ".
'z 01_� - -
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
tc5, of Bedrooms Date
This permit is granted to� / for.the installation of a septic tank -
at the residence of � 7` �^u �� �o. Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. p0
Manufacturer's Name AddressL-
i3a, of lines width in. Total�LLeength ft, lio. of Sq. Ft.
Type of filter material Total tons used 10*
Minimum Requirements: House Trai er Tank Cap.400
Sq. ft. line x+00
Two-bedroom house 00
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 6 % Signed:
Sanitarian
T. hereby certify that the above septic tank has been installed according to specifications.
Signed: 9, 4-A
. '-, X) A _tj 7 ep s nk Con ractor-�
i
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville,
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