P31369 Oak Grove Church Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
dIo. of Bedrooms � �--- Date
ibis permit is granted to �� ,�,7% L'a for the �-1a ion of'a septic tank..
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. _,96o
Manufacturer's Name Address
No. of lines.:__L_width�in. Total Length !3 ft. No. of Sq. Ft. OD
Type of filter material ,- /o c5Zp,&u, Total tons used , Q o
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line Eo
Two-bedroom house 0000
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.
Date of final approval Signed. _
Sanitarian
I rereby. certify that the above septic tank has been installed according to specifications.
Signed: 1
Septic T Co ractor
Note: Make sketbh of disposal, system on back of sheet and mail to Health Center, Mocksville.
��
�� �
rl