P1969 LangstonDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
`io, of Bedrooms .3 Date
This permit is granted to for the installation of a septic tank..
at the residence of C�C�s =�`�cvgSt Address , S h3g/--V ,
Building Contractor Qv,tlR�- Address
Septic Tank Specifications: Length Width Depth Capacity Gal.'a c�
Manufacturer's Name Address-����-�— �.
No. of lines widthin. Total Length�ds ft. PTo. of Sq. Ft. ��
T,�e of filter material --7;t/,p 101�1llrll. e_e Total tons used (n _
Minimum Requirements: House Trailer / Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to (specifications.
J_
Signed: � �� � Lol -- .-
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksvilh.
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