P10170 CartnerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms /e c- Date fO % — � O
This permit is granted to Ps 7'-, for the installation of a septic tank
at the residence of % d � ���r er— Address a�4
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. _/ 000
Manufacturer's Name 6-A o Q 4f Address)P7-. 3
No of lines / width in. Total Length 2:L6 ft. No. of q. Ft.�_�O o0
Type of filter material �� k e Total tons used J,rj
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom hous 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.
Note: Make sketch of disposal system on
Mocksville.
c
Signed,:
�,eptic Tank tractor
back of sheet a mail to Health Center,