2121 Cornatzer Rd Tx e C44 Yr-- V,e
DAVIE COUNTY HEALTF4 DEPARTIIENT SEPTIC TANK PERMIT
No of Bedrooms Date ["e 1. & J)QZ
This permit is granted to RuS.)i0*1 /,`s for: the installation of a septic tank
at the r4a4deuee of ag rc A o f 7%, %v;-, 6:o Address L�71'kj l
Building Contractor Address
Septic Tank Specifications: Length Width Depth C,a�placity Gal. DD `
Manufacturer's Name C /J o cL f' Address /—r i—.-.3�—� `No of lines / width-7 in. Total Length osCft. No. of Sq. Ft.
Type of filter material 4§6-lo 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: i
unitarian
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.
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