P42969 Deadmon RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
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,, of Bedrooms Date
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This permit is grante to �iz� � ,� L^� r for the installation of a septic tank'._.
at the residence of . �,✓� _ Address�,>
Building Contractor Address7—
Seutic Tank Specifications: Length ,G Width Depth_ Capacity
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I11Iencfacturer's N=12F .�X_ t �� � - Address—"
Uoe, of lines Width.Zjg' in. Total Length _2!aQ,._ft. bo. of Sq. rt.
Type of fil:cer material Total tons used _
MT..nii-tur. Requirements: House Trailer Tank Cap. 800 Sq. ft. line b00
Two-bedroom house 800 600
Three-bedroom house 900 900
!To one shall install a
o--,- his agent
Date of final approval
septic tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
i hereby certify that the above septic tank has been instal ed accordito s ifications.
Signed: �t?�-L.%
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Septic Tank Contractor
I'1ote: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.,