534 Fairfield RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
as of Bedrooms (,r,.4,�-� Date ZS ^ 6 r9 ---
''his permit is granted to _ for the installation of a septic tank..
at the residence of mac_ Address X211 Ll �
Building Contractor Address_
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
Ido. of lines__width „ in. Total Length1ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements:' House Trailer/Tank Cap. 800 Sq. ft. line 100
Two-bedroom house 800 6C0
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:
�v Septic Tank Contractor
PIS e: Make sketBh of disposal system on back of sheet and mail to Health Center, Mocksville.
�V/
;wy Jeff Gk
1