280 Lester Foster RdDAVID COUNTY I1;ALTH DEPIMPI IIT
SEPTIC TANK PLU-11T
No. of bedrooms Date
This permit is granted to for the installation of
a Septic Tank at the residence of La �. ______Address -r 'L- ;
Duilding Contractor Address `
Septic Tank Specifications: Length.Width Depth l 1.� Capacity Gal.
Manufacturer's Name Address
No. of lines Width (on in. Total length � ziFt. No. of Sq.,Ft.__" -) 11
Type of filter material _-1-71 � /r % -;� Total tons used 9
Niinir,=a Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
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: ' (,1cll--�La-__
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed
Septic Tank Contractor
Note: Flake sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.