P21370 Jericho Church Rd�-
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DAVIE COUNTY HEALTH DEPARVENT SEPTIC TANK PERMIT
No of Bedrooms =A crL(?
Date
/3
This permit is granted to
for the itallation
ff a
septic tank
at the residence ofAddres sGu�
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Building Contractor �
Add
Address
Septic Tank Specificatioes: Length
Width Depth Capacity
Gal. n� _
Manufacturer's Name �z24,-t,e� , C n
r Address /I 7�-
No of lines_ width in. Total
Length ,soft. No. of Sq.
Ft.
Lo Z)
Type of filter material . /v,
Total tons used
Minimum Requirements: House Trai r
Tank Cap. 800 Sq.
ft.
li' e 00
Two--bedr m Nous e 8.00
600
Three-bedroom house900
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 insted according to
specifications.7�-%
Signed': .A -A
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville. IqL�1�.