P52268 HootsDAVIE COUNTY HEALTH DEP TMENT SEPTIC TANK PERMIT
Uo. of Bedrooms - Date DL'2-
This permit is granted to er�w�-� L for the irstallati n oseptic ta:
at -Ulle residence of Adaress A�%�.
Bui ding Contractor Address
Septic Tank Specifications: Length Width Depth Capacit�y� � /1Gal . o 0
iMan�.`'ac�turer's Name C , �� c��s Addresses _1���`'. 5 ____
No. Tines_�g, width in. Total Length' ft. No, of Sq. Ft.
-It,-,e cf Filter material
Total tons used
1140.n.Lr:;'::.u:'-Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 500
Three-bedroom house //900 X90,,
c one shall install a seric tank in Davie County a permit from the Health Officer
or =_:;. s agent.
Date of final approval Signed:
Sanitarian
14ie'reky certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note- sake sketh:'. of disposal system on back of sheet and mail to Health Center, Mocksville.
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