P101471 Bermuda RunDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms_ Date/
This permit is granted to _ c for the installation of a septic! tankat the residence of L°� KAddress
Building Contractor ` Address
Septic Tank Specifications: QLength Width Depth Capacity Gal. 91,00 _
Manufacturer's Name/Ll� C� Address
No of lines_ width_.2_�in. Total Length o7 0 Cft. No. of Sq. Ft. to
Type of filter material �Total tons used c2,6
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line x+00
Two-bedroom ouse 800 600
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 hereby certify that the above septic tank has been installed according to
specifications.
Signed: y--5 � �
Septic' -Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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