892 Ralph Ratledge Rd (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms _ Date /? — — b,
'This permit is granted to Lc � L for the installation of a septic tank
at the residence of Q(7vu C1{' Address
Building Contractor i ��v �rL--� Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name ���,� Address
T?o. of lines`j—width_j�in. Total Length 3 dz, ft. Uo. of Sq,. Ft.
Type of filter material -W—Total tons used C;?5?1
Minimum Requirements: House Tra' er Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 90
Three-bedroom house900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Daae of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed: i
Septic Tank Contractor
:Tote: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville.