170 Mortgage Hill Way (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK'PERMIT
No of Bedrooms Date , 07a, /,9;?4
This permit is granted to �',ltl i J ooeLy for thenstallation of a s ptic tank
at the residence of Keflnqa AddressG1!-ela,17ars],PUNOcIrsv///e
Building Contractor a e Z e!2 Address
Septic Tank Specifications: Length Width Depth Capacity Gal. Q
Manufacturer's Name _ Address .3 0�
No of lines_ width i . Total Length c7ot�;ft. No. of Sq. Ft. 5 z>.0
Type of filter material ;z`l /a R Total tons used o?Sf-
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 90 900
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.
Note: Make sketch of disposal system on back
Mocksville.
Signed:
tic Ta Contractor
of sheet and mail to Health Center,
lk
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