P9969 Ridge Rd�r�( � DAVIE COUNTY HEALTH DEPART114ENT SEPTIC TANK PERMIT
No of Bedrooms `k »r.L Date _1 f
This permit is granted to for the installation ol a septid tank
at the residence of Cq ��Q>• 74- Fg rn7 s Address zf'W ,ad,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name ,_3a,,uo J', 7-, Address
No of lines_ / width u-ein. Total Length eft. No. of Sq. Ft. 4e xr,
Type of filter material 2 --- Total tons used /-,—
Minimum Requirements: House Trailer Tank Cap. 400100
Sq. ft. line 1+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 Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: �� ��eel-
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Pdocksville .