P42969 Hwy 64WDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No, of Bedrooms 6 Date Z�_ y—�T9
This permit is granted to 0i�� / ,� for the installation of aseptic ta_
the residence of t Address 3 3
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. .Id o
.3fnui'acturerls Name J�'ec. �1 ,^% [dam Address
Ice, of lines
__Z Total Length ft, No. of Sq. Ft.
2�� _ of filter material LCt�jittrn�� Total tons used
29.n.mum Requirements: House Trailer Tank Cap. 800 Sq. ft. line
Two-bedroom house 800 600
Three-bedroom house 900 900
:;o cre shall install a septic tank in Davie
or his agent.
Datc of final approval
County without a permit from the Health Officer
Signed:
Sanitarian
1 hereby certify that the above septic tank has been instal d accordi�� %to s�ifications.
Signed. _ �Q �C,C
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville�