P71867 Davie Academy RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
T'1(), of Bedrooms 1-3 Date /4 96, %
is permit is granted to for the irstalla o/of a s -pp is tank__
42/
::t the residence of ,-7, A Address 42 A�4;
Buildirg Contractor Address _
Septic Tank Specifications: Length Width_ Depth_ Capacity Gal, L
Manufac:turerz s Name _ ( t Address
Pit:,, of lines—&Z width 9'in. Total Length �3r-
ft. x`10. of meq. Ft.
of filter material � Total tons used � `� c
?✓� nimur, Requirements • House Trail r Tank Cap. 800 Sq. ft. line Z�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:
LSanitarian
T hereby certify that the above septic tank has been ins led accoz ng to pecificaticns.
Signed:
Septic Tank Contractor
Note: Make sketc':. of disposal system on back of sheet and mail to Health Center, Mocksville,
T
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