P9867 Ijames Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
..). of Bedrooms Date
:':his permit is granted to for the installation ofa�c tank
at the residence of Address ��� ` �LV s C /
3uilding Contractor Address af
Septic Tank Specifications: Length Width Depth Capacity Gal. cJJ
c
A4anufacturer's Name Address
No. of lines width in. Total Length ft. No. of Sq. Ft. o 0
Tae of filter material � ��,���z Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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.
De.te of final approval 7-9-67 Signed:
Sanitarian
i hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
?,aot.e: Make sketBh of disposal system on back of sheet and mail to Health Center, Mocksville.
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