P10468 Hemlock StDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
I. o, of Bedrooms 4 Date 1,1,4
.:nis permit is granted to for the installation of a septic tams,
at the residence of qe ,z �.c.� ����� Address
Duiading Contractor 7 Address
Septic Tank Specifications: Length Width Depth Capacity Gal. O n
Manufacturer's Name .�fL _ ��� Address
1
No. of lines/—width F . in Total Length ft. No. of Sq. Ft Zip
Type of filter material �,� G`1 � ��Q Total tons used
T,linirama Eequirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 00 600
Three-bedroom house 900
No one shall install a septic tank in Davie
or his agent.
Date of final approval
County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been instled accord' t ecifications.�
Signed: /.
G
Septic/Tank Contractor
Note: Make sketbtz of disposal system on back of sheet and mail to Health Center, Mocksville,
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