P12467 Prison Camp RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'o, of Bedrooms Date - Z , 6
-his permit is granted to, 71 u i P .7 Ce, . for the installation of a septic tam__
,.t the residence of enn e r Address
DU4 iding Contractor Address
SeT)tic Tank Specifications: Length Width Depth Capacity
Manufacturer's Name ���L,�' , Address��
T?o,, of lines_-4--yidth�in. Total Length t. No. of Sq. Ft. ep->
y,pe- of filter material 77 o Total tons used „21
J.nimum Requirements: House Trailer Tank Cap. 7800 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 Office;
or his agent. n
Date of final approval /' - r? - G 7 Signed:
_T Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
/ '� -2 3l Signed: / -p
L, tic Tank Contractor
Note: Make sketb'_a of disposal system on back of sheet and mail to Health Center, Mocksville.