P101167 Cana RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
�d >� of Bedrooms �3// Date /D -- //- 6 `7
This permit is granted to G r4 /i a- 7°7 o n for the installation of a septic tank.-
Ig
at the residence of Address 14-,S-
L
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 'D O
Manufacturer's Name Address
No. of lineswidth �3(p in. Total Length 30o ft. No. of S Ft. Q�
Type of filter material Total tons used
:Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 8 0 600
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. �n
Date of final approval 67 Signed: t
Sanitarian
/I hereby certify that the above septic tank has been inst lled according to pecifications.
Signed: /
SeptX Tank Contractor
Note: Make sketch of disposal system on back of she t and mail to Health Cent , Mocksville.