145 Sheffield Rd Lot 10DAVIE COUNTY HEALTH DEPAR'nZNT SEPTIC TANK PERMIT -
I�
No of Bedrooms Date //z/
This permit, is granted to d,r, q for the installation of a septic tank
at the residence of Address/
Building:Contractor � �c Address dG a QUI �o
Septic Tank Specifications: Len _ h Width Deph Capacity_ Gal. 9 �d
Manufacturer's Name�"
�/�.1tw,ilt � %�,. Address .
No of.lines_� width 5! in. Total Length y2��ft. No. of Sq. Ft. 90b
Type of_filter material Total tons used %0
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house goo 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 hereby certify that the above septic tank has been installed according to
specifications.
Signed: 42!!f
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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