P9270 VanDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms .3 Date e�%� 2-- , /i- O
This permit is granted to for the installation f a deptic tank
at the residence of -W;k4,V-Q-7 I. ddress PA67, Ad L'on C -
Building Contractor Q uc4a /no Address .o? cle
Septic Tank Specification : Length Width Depth Capacity Gal.
Manufacturer's Name Address 3,
3,
No of lines Sr width �� i Total Length oo ft. No. of Sq. Ft.
Type of filter material ,—Zr, — Total tons used
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.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.