208 Boxwood Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms �i z ��� Date �? -/I-/ - � r
'Fais permit is granted to for the installation,) of a septic
-t the residence of :Y_,c;, _ Address
Building Contractor Cl Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name
I?o. of lines width in. Total Length
lype of filter material
Minimum Requirements: House Trailer
Two-bedroom house
Three-bedroom house
No one
or his
D at e c
Address______��
ft. No. of Sq. Ft.
Total tons
Tank Cap.
800
900
used
Sq. ft. line 440005ol
900
shall install a septic tank in Davie County without a permit from the Health Officer
agent.
final approval _ Signed:
Sanitarian
T hereby certify that the above septic tank has been inst, according to s ecifications.
SHSTONE CO
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mockeavilleo
Gay _T�l7�
i