P1665 Davie Academy Rd q Vie, hajew
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PM-rIT
No., of Bedrooms 3 Date ���-�lv 5—�.
This permit is granted to VA ,) � �' S�O/, f` �i��l�'��_ for the installation
of a Septic Tank at the residence of y.�.,fl S.9/t� Address
Building Contractor� Address
Septic Tank Specifications: Length Width Deptl,_____Capacity O o o Gal„
ManufacturerI s Name�1 A C' Se `c �i4>,/� . Address t�
No. of lines .Z Zndth in. Total length ft. No. of Sq.Ft. o
Type of filter material 5�7`a�/� Total tons used -31 , 32—
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Tiro-Bedroom House 800 600
` Three-Bedroom House 900 900
Ito one shall install a septic tank in Davie County without a perrai.t from the
Health Officer or his agent.
Date of final approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed
Septic Tank Contractor
Note: I•Zake sketch of disposal system on back of sheet and mail to the Health
Center in Mocksville.
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