P111067 BogerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
ico, of Bedrooms i Date
hi.. permit is granted to CtK J for the installation of a septic tangy:.
at the residence of Address
Building Contractor 1 •-`_..c.ac*� Address
Sentic Tank Specifications: Length Width Depth Capacity Gal, U
Manufacturer's Name �t�.—_..� Address C>-,—I-Gc`��* � + 3, IV, `.
i
Iio, of lines_Lwidth�in. Total Length j ► D ft. Uo. of Sq. Ft. o U
Type of filter material Total tons used
M-inimum Requirements: House Trailer Tank Cap. £300 Sq. ft. line 400
Two-bedroom house800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval / - i o 7 Signed:
Sanitarian
I. hereby certify that the above septic tank has been installed according to specifications.
Signed:
Se is Tank Contractor
Note: Make sketbh" of disposal system on back of sheet and mail to Health Center, Mocksville.
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