Clement, Ray Hwy 601DAVIE COUNTY 9,ALTH DEPARTiMT
SEPTIC TANK Ph -M -IIT
No. of Dedrooms _ _ Date
This permit is granted to J1 E� �'�l�Ao�Lc. r t installation of
a Septic Tank at the residence of, Address
Address `�`."�� �/!�•
Puilding Contractor ��_ Address_
Septic Tank Specifications: Length /dz�� 11idth 4/ Depth Je4 Capacity�� Gal,
Manufacturer i s Name Address��Z',/
No.
of lines 2, Width -in.
Total length rV Ft.
No. of Sq,Ft, 00
Type
of filter material zo
Total tons
used
Tiininura Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two-Dedroom House 800 600
Three-Dedroa- House 900 900
No one shall install a septic tank in Davie County tirithoat 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
Septic Tcixik Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksvil] e.
6(w