P71469 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
`Io, of Bedrooms Cz- Date�1
This Hermit is granted to for the installation of a septic tam;
at the residence of s`�%�� Address 17Z, 3f"t,9C1a4,
Building Contractor Address )
Septic Tank Specifications: Length Width Depth Capacity _Gal. �Q �
Man-�lfacturer's Name Address
No.. of lines__/ width__�'/in. Total Length _ eft, No. of Sq. Ft. d"z
Tyrpe of filter material Total tons used O
14- .n i.mum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1 o0
Two-bedroom house 800 600
Three-bedroom house 900 900
11c one shall install a
or his agent.
Date of final approval
septic tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
T hereby certify that the above septic tank has been installed according to specifications.
Signed:✓
;- Septic Tank Contractor
Note: Make sketb.a of disposal system on back of sheet and mail to Health Center, Mocksvilleo
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