196 Wandering Ln Lots 82-84 P/O 85DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is granted to-Tamxfor the installation of a septic tank
at the residence of ��� � Address Q n 4&- 'K LA /, 0 -r-, k S. U,'�R
Building Contractor Address
Septic Tank Specifications: Length Width . Depth Capacity Gal. cj O p
Manufacturer's Name �T�LI; p ,% L o Address IP
c L S ✓11co. All
No of lines tiridth in. Total
/�--Length ft. No. of
Type of filter material S Total tons used02
Minimum Requirements: House Tr ler Tamlz 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 `�� _V d �6 1- -�, )I
S ptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.