Studevent, LesterNo. of Dedrooms ._
DAVIE COUNTY H;PALTH DI PSaYl NT
SEPTIC TANK PIiJi-uM
Date 9 —P — 6 --3
This permit is granted to for the installation of
a Septic Tank at the residence of .. Address?��►a .�,
Building Contractor Address
:septic Tank Specifications: Length 1idth / Depth Capacity
_2,0
1-1anuf acturer I s Name ,j�- �? Address
No. of lines Width�in. Total length o Ft. Ido, of Sq.Ft. 06
Type of filter material Total tons used ;7J"-
1,dniTixt-a Requirements:
House Trailer
Twc--Dedroom House
Three-Dedroom House
Tank Capacity
500
800
M
Square Ft. of Line
1;00
600
900
No one shall install a septic tank in Davie County -vrithout a permit from the
Health Officer or his agent.
Date of final Approval ��f — G `Signed;
Cl Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed 10
_��.�• ,-,rT.0
Septic Tank Contractor
Note: Flake sketch of disposal system on back of sheet and mail to the
Health Center in 11ocksville.