P71665 MichaelDAVIE COUNTY HEALTH DEPARTEINT
SEPTIC TANK PITUI-IT
1
No. of Bedrooms oDate
Thi_; permit is granted to for the installation
of .� Septic Tank at the residence of �U✓r,�rC_ bq z Address �_5 1K) C_ S v;.//� /w
Building Contractor _,Z,�/l/)f��Address r ��j/moi' !//,--
c�
Septic Tank Specifications: Length Width Depth Capacity Gal.
I.ianufacturert s Name ?���/� ! t, j'�%��/ E 6e). Address /�/UC�•�'`�%/�,��/
No. of lines Uidth_ a/ in. Total length js2 ft. A?( A of Sq.Ft._,t.�Ov
Type of filter material "eT j/li ��� Total tons used r'/;;;) _
I i:!imw-n Requirements: Tank Capac_ty Square F"., A Line
b
House Trailer 8100 100
Two -Bedroom House 600
Three -Bedroom House 900
No one shall install a septic tank in Davi: County without a perrii.t fr j.:. the
Health Officer or his agent.
Ll
Date of final approbal Signed: 1,
_
Ste, iiitarian
1
I hereby certify that the above septic tank has been installed according too
specifications.
Signed Z__•
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the Health
Center yin llocksville.