119 Sheffield Rd Lot 7jI4 g,eRAe .- - ;/SEPTIC
DAVIE COUNTY HEALTH DEPARTMENT TANK PERbtIT Date
Oxner/Occupant D 11P u. /d��.�0 G. To: 1 /9'y%lO dam%
4'
Address Ay /,6 P M7 .A,Qt/ n! e" Address ��yl� /
Building Cf p, QLcto;' ' i%lr1 P / Address `1' D t �.
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Cal. �D ,Manufacturer's Name ��2 7—,fAddress
No. of lines Width in. Total length t. Nosq. ft.
00
Type of filter material !�%o 57-ei1P Total'tons`used FA
-749D121
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 aseptic tank in Davie County without aipermit�,from theiHealth Offic
or his agent, t j
Date of Final Approval 1'—.:z , 9 -L Signed:
I hereby certify,that the above s$ptic-tank has been installf
Signed:
• f
Orr
Note:;, Make sketch of disposal system on back of sheet and m
Center, Box 57, Mocksville, North Carolina 27028.
inLy to?sneca ficatior
C 'ranK contractor
I ,
io'Davie County Health
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