P72569 Hwy 158 - Disher Trailer ParkDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'zo, of Bedrooms Date
"his perzit is granted to for the installation of a septic tank
at the residence of Address /S8 _
Bu i. Coi:ti•actor ._ Address _:Z31 `L,
Sc -)til, Tank Specifications: ength Width_—_ Depth— Capacity Gale 4���_
�S�afa: ure.r's
Name �,cCAddress
- 74�_
(1c, of lines_ width min. Total Length _3 oa ft. No. sof Sq. Ft. 90_-0_� �
11 Vii.'. of i 1tcr material /o Total tons used
i;ar�i�a:aui equiretr�ents: House Trail Tank Cap. 800 Sq. ft. line 400
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.
Dat,_- of final &,pproval Signed:
Sanitarian
T..^erebli, certify that the above septic tank has been i celled ac ord*n to specifications.
Sign' -d:
�
Septic Tank Contractor
Note: Make sketc".. of disposal system on back of sheet and mail to Health Center, Mocksville.
io �P'�=� eH 6L-4 -