1036 Fork Bixby Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Tof Bedrooms Rq ;Pers —2 Date
This permit is granted to ph- for the installation of a septic tank..
11;1 9 at the residence of L es�e v- ���K C h� Address un11S roe
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity _Gal. �O
c
Manufacturer's Name`y�Q f/�`� �,�� Cv� Address
No. of lines�c� width_.29in. Total Length /3 ft. No. of Sq. Ft.
1jpe of filter material Total tons used
Idinimuin Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 60o
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.
mate of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed: - GA -4/02tt-ice'
Septic Tank Contractor
Note: Make sketb. of disposal system on back of sheet and mail to Health Center, Mocksville.
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