1913 Hwy 601S - Luthern Church ParsonageDAVIE COUNTY HEALTH DEPlaThENT
SEPTIC TANK PhMl-IT
No, of Dedrooms ,.3 Date 7-
This permit is granted to -7,kj;(, moi( �d. for the installation of
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a Septic Tank at the residence of NN Address �4 P e-
Duilding Contractor /—w zoo 4.0A,Pl Address �u%C #�r oaii'V..//t0
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Septic Tank Specifications; Length .L�'VidthSK �r Depth Capacity DD Gal
11anuf acturer I s Namev P S� // l' / � �D Address oC! /I--
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No. of Lines Width 7V in. Total length Ft. No. of Sq. Ft.
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Type of filter material a— Total tons used /2 /3
iinihiiim Requirements; Tank Capacity Square Pt. of Line
House Trailer 800 100
Two-Dedroom House 800 600
Three-Dedroai House 900 900
No one shall install a septic tank in Davie County irithout a permit from the
Health Officer or his agent.
Date of final Approval
Signed;
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed ..OL6�,d ae_'Z_�
Septic Tank Contractor
Note; Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksvil].e.