P102866 HowardDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date
This permit is granted to for the installation of a septic tank__
at the residence of Dl,Jar d, 4;/q /�'�. Address "' T, f�dyQ �� c- f, � e -
Buiiding Contractor Address
Septic Tank Specifications:/ Length/ Width Depth_ Capacity Gal. u -a -��
,Manufacturer's Name nDq-t--/ �ido�.��gz`P f�n�cv ddress %e X; a9
Ila.. of lines___width__-? in. Total Length ft. No. of Sq. Ft.
Type of filter material
Total tons used
M.nimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two -be room Ouse 00
Three- e room house 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval Signed: c it�.cce
Sanitarian
1 hereby certify that the above septic tank has been installed according to specifications.
Sinned:
Septic Tank Contractor
Note: Make sketc-- of disposal system on back of sheet and mail to Health Center, Mocksville.