P62168 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
TY c> of Bedrooms 13 Date C
`nia permit is granted to �`c�u.�-� �.7, � �-
for the installation of a septic tank
:e,.. the rc: idence of Twf allLo _ Addresses
Building Contractor
Address-l��&
(yz'�-"Q
Sentic Tank Specifications:
-
.a:iufacturer's Name �
Length
4 ' T'
Width Depth Capacity Gal. _ e6
Address V �
No. of lines-----/ width in. Total Length c2a t.
Type of filter material Total
No. of Sq. Ft. -.Zao
tons used
l.ini:.ixf. ',ZequireInents: House Trailer Tank Cap. 800
Two-bedroom house 800
Three-bedroom house 900
7o one shall
o' '1 a - e u
Pate of final
Sq. ft. line 400
600
900
install a septic tank in Davie County without a permit from the Health Officer
approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note--i-Make sketa'_ of disposal system on back of sheet and mail to Health Center, Mocksville,
72D�-�-tea,.--� �c-�
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