P41370 Jericho Church Rd..,. , ..
., ,
... ,..., �_. ,. _.�� �..: T._ .: .. ._,.. ._� ..._ ... _. .. ... ..� .
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms
Date 1 — /3 —
� O
This permit is granted to
for the installation of a
septic
tank
at the residence of 72a, Z& L 4?07M `M
_ Address
Building Contractor kfef,ry
Address �.
Septic Tank Specification Le�gth
Width Depth Capacity
Gal. 2
Manufacturer's Name
Addressilc
No of lines width in. Total
Length ft. No. of
Type of filter material
Total tons used
Minimum Requirements: House Trailer
Tank Cap. 800 Sq. ft.
line
400
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
I hereby certify that the above septic tank has been ;rLpding t
specifications.
Signed: �i
Septic TA Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.