P10666 No Creek RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Io, of Bedrooms `) _ �— / Date
-hispermit is granted to �� e e % C 1 i �z.. for the installation'of a septic tank__.
at the residence of W; (linin S Address �� ,ei✓ATz_
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. G'o
N,anufacturerI s Name " ,Ain P Address S";'9 in e
IIo, of lines width 1 _'L in. Total Length ,AA j ft. No. of Sq. Ft. q c� o
Type of filter material 5 i n(e I Total tons used :3,/ 3 2— % �✓
M.-Knimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line I+00
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.
Daae of final approval Signed:
Sanitarian
1'. hereby certify that the above septic tank has been installed according to spe 'fications.
Signed: ,..� _
���,� �rL
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
.�A d � �j 1
s