P7166 O'NealNo. of Bedrooms oZ
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PER1v!IT
Date �-/-Z,<�,
This permit is granted to for the installation
of a Septic Tank at the residence of ,, Q Address /61, / ocD r
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity ±f- o Gal,
Manuf acturer Is Name lJ'ccwy r�',% , Address
No. of lines Vidth_ % in. Total length j s --D ft. No. of SgXt.�
Type of filter material Total tons used
Minimum Requirements:
House Trailer
C—Two-Bedroom House
Three -Bedroom House
Tank Capacity
_m
Square Ft. of Line
400
600
goo
No one shall install a septic tank in Davie County without a perrait from the
Health Officer or his agent.
Date of final approbal - - Signed:�
r/ Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed-
-� T Septic Tank Contractor
Note: riake sketch of disposal system on back of sheet and mail to the Health
Center in I,locksville.