P11967 Edgewood Cir DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT//
o, of Bedrooms _ Date y W/ c/
.his permit is granted to d,9y��c� sem/ /�� a, for the install tion of a septic tank__
at the residence of � , � Address �oo �f.,/ylPP /2-4/0114k;000
Building Contractor / , i, Address
Septic Tank Specifications: Length Width Depth Capacity Gal. /9.00
Manufacturer's Name -) )Q v;t0 S /L`� -7-,--g-.PIW- Address / 'ate 08� /-
No. of lines width-(tin. Total Length a:�:S- ft. No. of Sq. Ft. �?D o
Type of filter material S / o n/-P Total tons used 3 z - 3
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom. house 800 600
Three-bedroom house 900 goo
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 spenifications.
Signed: _
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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