187 Liberty RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 1 u 5e _ //�it1' PSP _ Date 13 X7/ 7/
This permit is granted to` ie ` =-1Wk for the ins llation of a peptic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. '900
Manufacturer's Name DA-, 1 P �/ic / ,Q�i( Address'4- e
No of lines I width in. Total Length /Glp ft. No. of Sq. Ft. O o
Type of filter material S -7-0-W e Total tons used
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 accor g to
specifications.
Signed: CA424d,
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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