P81269 Hwy 801SD IE COUN Y HEALTH DEPARTi•IENT SEPTIC TANK PERMIT
o, of Bedrooms Date
Thisp•�= nit is grante o for the installation of a septic tanl .
at the residence of PY'S_ Address / c�✓a
Building Contractor Address
Septic- Tank Specifications: Length _Width _Depth Capacity_ Gal<
Ma:� lfacturer's Name CLO,?- y Address ..-
tao, of l.ine:width in. Total Length ft, fo. of Sq. Ft,
1';y e of _filter material 7Y _Total tons used p+,
r11 _nJ_";. mi Requirements: House TrailerTank Cap. 800 Sq. ft. line �4C0•
Two-bedroom house 800 QOJ
Three-bedroom house 900 900
No :ane shall install a septic tank in Davie
orris agent.
of final approval
County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
?Totes Mahe sket*v: of disposal system on back of sheet and mail to Health Center, Mocksvilleo