114 McClamrock Rd (2) DAVIE COUNTY HEALTH:DEPARrnIENT
• '- • SEPTIC-TANK PERMIT_
No of Bedrooms ; Date u u /9
This permit+ .ia: granted to &S 0-n Rllls for the ins allatiorf of a se is tank
at the residence of Zo- nn Address
Building Contractor Address —7
Septic Tank Specifications: Length Width Depth Capacity Gal. 5;d"P
Manufacturer's Name .5170, Address eO41 _
No of lines width_,L( in. Total Length !j ft. No. of Sq. t.
Type' of filter. material � �,,,,,� Total tons used f
Min ,m Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
I Three-bedroom house 900 900
Nojoneshall 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: &
- -- - _ Septic Tank Contractor
Note: Make- sketch- of disposal system on back of sheet and mail to Health Center,
Mocksville.
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