P82065 Hwy 158DAVIE COUNTY HEALTH DEPAR.Tt,,ENT
SEPTIC TANK Palv=
No. of Bedrooms .2 Date D
This permit is granted toi�2=�JeA . ZZ;, s - �%p., ,y.+a for the installation
of a Septic Tank at the residence of jCt �,;,, Address
Building Contractor
Address
Septic Tank Specifications: Length _AdthDepth 4 (l Capacity ld ,(D G,!"
MTanufacturer's Name - Address
'nj
No. of lines .IL Width ^in. Total length '200 ft. No, of Sq.Ft. 4 d0
Type of filter material
minimum Requirements:
House Trailer
Two -Bedroom House
Three -Bedroom House
Total tons used
Tank Capacity
800
800
900
Square Ft. of Line
400
600
goo
No one shall install a septic tank in Davie County without a permit from the
Health Officer or his agent.
Date of final approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. p
Signed 1�/�� ✓c
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the Health
Center in hiocksville.
I