P102168 Boxwood Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Tc`o- of Bedrooms Date Date 4 6
permit is granted to c .� �' %' s for the installation of a se7itic tanl�..
at the residence of i��'rrc c _ Address Aay2-
Building Contractor Address _
Septic Tank Specifications: Length Width Depth _ Capacity Gal. 9,0C)
Manufacturer's Name ��} , ,_���`' / L� Address
No,. of lines-width�in. Total Length a:'D ft. qlo. of Sq. Ft.
TkV e of filter material 77` lo �, rte_, s,-._� Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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:
Sanitarian
I hereby certify that the above septic tank has been inst led accor " g to pecifications.
Signed:
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville,,