188 Center Circle Lot 21DAVIE COUNTY HEALTH DEPARTMENT
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SEPTIC TANK PERMIT. ��,'
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No of BedroomsDate .? r3 "Jp2=� / 1
This permit is granted to �� i./for the installation of a sept c tank - ,
at the residence of Address J .—�
Building Contractor % :Address 77DF--�� 11 , \ /}awl
Septic Tank Specifications: Length Width Depth_ Capacity_ Gal..!
Manufacturers Name C ly Q �/� /�A e, ; ; � Address 6—, /li�-r..._ .. 1 f
No of lines_ widthin. Total Length a r.__ No:'o'P S . Ft.DO )y
Type of filter material jp p%rraaJiy Total tons used - 1;10? ---✓V
Minimum Requirements: House Trailer 'Tank Cap.i 800 Sq. ft. line 400 !�
Two-bedroom house 800 600
01
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit f m the Health
Officer or his agent. ��/J/J,_,_ 'D I
Date of final approval �//_!_lf�+4l o't3 , /% `%C -H, Signed: <
anitarian
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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