P72767 Walt Wilson RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms � _ Date
this permit is granted to for the installation of a septic tank
� yy
at; the residence of .—Address
Building Contractor Address
Sentic Tank Specifications: Lenpgth V4R?-Width_ Depth /Capacity Gal, 9 Rp
Manufacturer's Name c_`p .{, _ Address 7gz ? Q4 Al
No of lines_-L—width_4rS( in. Total Length fob ft. lTo. of Sq. Ft. (p00
�- o9 /
of filter materials Total tons used
14inirmum Requirements: House Tr ler Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shal-I install a septic tank in Davie County without
or }:.s ;agent.,
D<�i:e of final approval
V
a permit from the Health Officer
Signed:
Sanitarian
1 hereby certify that the above septic tank has been installed according to specifications.
Signed: -� -
S tic Tank Contractor
Note.: Make sketbb of disposal system on back of sheet and mail to Health Center, Mocksville.