676 Cornatzer RdDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms __11�_ Date & le-9,�
This permit is granted to 2wil nK,E4" for the installation of a septic tank
at the residence of <�_E'.nrgp S`7'a rr Address K-1.3. . Mee_ s aL//g�
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. L �y
Manufacturer's Name Address/ ,' o?
No of lines_„ widths in. Total Length tl ocft. No. of Sqit. cc,
Type of filter material �,� ;� Total tons used r1gl
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 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: &,C,�7o7 Z-&�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.