3911 Hwy 601N (2)--v
Y' J
DAVIE COUNTY HEALTH DEPARTt7ENT SEPTIC TANK PERMIT
No of Bedrooms-==.�-rf�-f�`�cs�` �2 dJ s� Date
This permit is granted to for the installation of a septic tank
at the residence of ,Q�rc , r �! �` s� ; ��� Address �f C;?
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name
No of lines width in.
Type of filter material
Minimum Requirements: House Trailer
Two-bedroom house.
ree- edroom ouse
No one shall install a septic tank in Davie
Officer or his agent.
Address
Total Length ft. No. of Sq. Ft.
Total tons used
ank Cap. 800 Sq. ft. line 400
ano 00
900 90
County without a permit from the Health
Date of final approval /02 - 0 3 - 9 4-- 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 .
x 3
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