P83167 FosterDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
P..). of Bedrooms Date
"phis permit is granted to V 5- Ir for the installation of a se
'pt ic tank
at the residence of �it.H A9-11 Address
Building Contractor `' e Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 1 cr3
Manufacturer's Name-7�a4tu Address IjIf,U �a,
No. of lines width/'9in. Total Length ft. Xo. of Sq. Ft. y da
Type of filter material AZM-o_/o Total
Minimum Requirements: House Tr4ler Tank Cap.
Two-bedroom house
Three-bedroom house
tons used
800 Sq. ft. line 400
800 600
900 goo
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:
Sanitarian
I hereby certify that the above septic tank has been inst led according t pecifications.
Signed: �✓' -
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville,
`,!�3-2.�^a'� x'3'"0 / —� -. �..