P101571 GilleyDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
I-;---
No of Bedrooms �� Date %P / 9
This permit is granted t hio� �.T_ 'r for the installation of a septic tank
at the residence of r / Address�jley
Building Contractor Address
Septic Tank Specifications: Length Width ,p Depth Capacity Gal.
Q
Manufacturer's Name ?— �. Address `
7
No of lines_ width 3 4� in. Total Length / Oft. No. _ Sq. Ft. 3 �
Type of filter material t� pCym�/Ly 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
Officer or his agent.
Date of final approval
County without a permit from the Health
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: a�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
- � - - ., r � .. .