225 Williams Rd o�'� plae-e lea
DAVIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms Date /a-L
This permit is granted to �� C for the installation of a septic tank
at the residence of Address t.3lU��,�.C� :, �1� )''✓1
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name c -'�'� Address
No of lines o?. widths in Total Length ,3crJ ft. No. of Sq. Ft. ?c7 �
Type of filter material
--Z D 42?z,,- Total tons used 3 Q
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a v
septic tank in Davie County without a permit from the Health
t 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: 4gz�(
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville
.�.:,^'_«
r; ,.r y�. � } .. r, -'• `..r��� .'�1._�..,_ _ ._... ...rf .}CY`:i, �.+ ���1 f.'r.._7t_ _f�� J�• •