P2667 Sain RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
o, of Bedrooms I / �_..' _, 1 Date
'.'hi , permit is granted to ', % ; [��, for the installation of a septic tank__
.t, the residence of Address
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Building Contractor ,i: CL -, .,, ! %�r'1��_ - .,..� Address
Si:Dtic Tank Specifications: /Length Width Depth Capacity Gal 4+Jr^ _^r
Manufacturer's Name _=�i.t3`�'[� Address
No. of lines .-Z width 10 /Fi! . Total Length 4,4G ft. :io. of Sq. Ft, j�iZO
Type of filter material �:L�., %�.('� i._v Total tons used
Minimum Requirements: House Trailer Tank Cap. 80 Sq, ft. line ;--400��
Two-bedroom house 800 06 0
Three-bedroom house 0900% 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 , �, -(o �� Signed:4f
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Sanitarian
I hereby certify that the above septic tank has been installed according to *pecifica,tions.
Signed:
Septic Tank Contractor
Note: Make sketba of disposal system on back of sheet and mail to Health Center, Mocksville,
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