P12266 Woodward RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
i.o, of Bedrooms Date /.Z
'hi -s permit is granted to cEe2 L for the installation of a septic tank-;
at the residence of cL , u''-� _ Address
:3u :din, Contractor Address
Septic Tank Specificati Length Width Depth_ Capacity A Gal,
Manufacturer's Name Address �•.�' 1 ��.,
iI . of. es wi h t 'A` Total Length 5 ft X of �Ft .
o, lines dt _a_ 0 1 ngt _ q. _
'Py e, of filter material Total tons used
`fi n Lr�an Y,equirements • House Trailer Tank Cap. 800 Sq. ft. line 400
• TwoTbedroom house 800 6oc
three -be room house % 900+ 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date o_'' final approval /� - , � � Signed:
v Sanitarian
I
hereby certify that the above septic tank has been installed according to specifications:
Signed:1 ti
S6fptic Tank Contractor
Note- Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville,
t�