P4369 Ijames Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
,.o:, of Bedrooms F_ r Date T/� - •3 - �, �'
This permit is granted to cr.� i��L� for the ir_sta ation of a septic tank..
at -the residence of Address
Building Contractor Address
SeT)tl c Tank Specifications: Length L-*�'bWidth__Depth_ Capacity a -p Gal.
,Ianufacturer's Name Address
P.o, of lines__�_ width in. Total Length J ajn_ft. :5o. of Sq. Ft.
Type of filter 4 . er material -L.Jk Total tons used
.Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line I+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
Date of final approval Signed:
Sanitarian
17 hereby certify that the above septic tank has been installled according t pecifications.
;k�Signed: -r,
Sep c Tank Contractor
Note: hake sketb'-' of disposal system on back of sheet and mail to Health Center, Mocksville.