138 Deadmon Rd '-�Jlwom & o
DAVIE COUNTY HEALTH DEPARTiiENT 'V /
SEPTIC TANK PERMIT
No. of Bedrooms `���^ Date / 3 'Ju 3
This permit is granted to J)�q eo,for the installation of
a Septic Tank at the residence of Ii/l/S�Address
Building Contractor N JA Address (Vie
Septic Tank Specifications: Length I L- Width_ 5 Depth 4n � Capacity 900 Gal,
Manuf acturer I s Name)Au;e S'j� / o. .-Address.Alf-lf- ' t
No. of lines .2 Width9 in. Total length 1 SO Ft. No. of Sq.Ft,
r ,
Tyne of filter material r L � T�' Total tons used ;a
Mi.nimma Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two-Bedroom House 800 600
Three-Bedroom House 900 900
No one shall install a septic tank in Davie County vrlthout a permit from the
Health Officer or his agent.
Date of final Approvaly2 " 6 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications. f�
Signed
Sbptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville,,
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