181 Oak Grove Church RdDAVIE COUNTY HEALTH DEPARYMENT
SEPTIC TANK PM1IT
No. of Bedrooms _:;_I Date
This permit is granted to or the installation
of a Septic Tank at the residence of -ez/ Address P-/ 3
Building Contractor Address
Septic Tank Specifications: Length 47 6 Width �L_Depth "Capacity %Q a Gal,
Ma.nufacturerI s Name J` de, Address
_2,o o
No. of lines Mdth3,6_in . Total length ft. No. of Sq. Ft .G�,0 d
Type of filter material 7alnA Total tons used .26
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer £300 100
Two -Bedroom House £300 600
Three -Bedroom House 900 900
No one shall install a septic tank in Davie County without a perridt from the
Health Officer or his agent.
Date of final approbal
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
SJ
igned Com-. `
Septic Tank Contractor
Note: I -lake sketch of disposal system on back of sheet and mail to the Health
Center in Hocksville.