P81870 CookDAVIE COUNTY HEALTH DEPARTIIENT SEPTIC TANK PERMIT
No of Bedrooms Date L&9Q AO
This permit is ranted to tno for the install do of a septic tank
i (7y t v
at the residence of ��/r Address 4�S , A/0 c. /*s v;,11cb
Building Contractor Address
Septic Tank Specifications: Length Width Depth ..Capacity Gal. Qoa
Manufacturer's Name _ Address . 3
No of lines_ widtha(, ip. , Total Length c?oe)ft. No. of S /. Ft. 000,x, l_
Type of filter material Total tons used t2-
Minimum
2Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom housr- 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 insta ed accor ing to
specifications.
Signed: ' e -z-<—
Septic Ta Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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