522 Baltimore Rd (2) DAVIE COUNTY HEALTH DEPIaM. NT
SEPTIC TANK PM.1IT
No. of Bedrooms Date
This permit is granted to //, ,.I'� �,f�• / _ for the installation of
a Septic Tank at the residence ofd Ly ..-. _Address0
Building Contractor Jin, WA ,'4,, 1-
,--n Address
Septic Tank Specifications: Length Width Depth Capacity . 6 4 Gal.
llanufacturer t s Name ,y J,o� �,, J1�( Address
No. of lines J' WidthIL in. Total length - Q p Ft. No. of Sq.Ft. 9
Type of filter material c, Total tons used
Minimum Requirements: Tank Capacity Square Ft. of Line.
House Trailer 800 100
Two-Bedroom House 800 600
Three-Bedroom House goo 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:
Sanitarian
I hereby certify that the above septic tank has been-Installed according
to specifications.
Signed
Z7/es 'f"z� « 7a x _ Sc-'r,
ank Contractor
Note: Make sketch ,of disposal system on back of sheet and.mail to the
Health Center in Mocksville.
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