2091 Junction Rd (2)DAVIE COUNTY HEALTH DEPART=NT-,VK SEPTIC TANK PEM1IT
of isedrooms, Date - -6
his permit is granted to c,.,, , for the installation o . aseptic tank__
at the residence of u? se —Address
Duilding Contractor Address
Seri is Tank ftecificatio4" : Length [width � Depth_ Capacity_
Manvfac-t-arer's Namec�L ,7 _ ' ,_ - Address
Gal,
I?c., of lines width '; in. Total Length 1,5-0 ft. lo. of Sq. Ft.
9`rL.e of filter materialr'. Total tons used
MJ.nimiun Requirements: House/Trailer Tank Cap. £300 Sq. ft. line 1,00
Two-bedroom house 500.. 600
Three-bedroom house 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 � - `� - 6 % Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
i /Septic/Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville
0- ... 7 -,,-�