P33171 Liberty Church RdDAVIE COUNTY HEALTH DEPARnIENT SEPTIC TANK PERMIT
No of Bedrooms a Date 3 -3 / — V
This permit is granted to 7trr r„ for the installation of a septic tank
at the residence of Q d 'c Address
Building Contractor D Address
Septic Tank Specifications: Length Width Depth Capacity Gal. y o 0
Manufacturer's Name dlP S , &, Address
No of lines_, width in. Total Length / Sa ft. No. of Sq. Ft. 0 0
Type of filter material _�Tank
Total tons used %
Minimum Requirements: House Traile. 800 Sq. ft. line 40'0
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic
Officer or his agent.
Date of final approval
tank in Davie County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Note: ak ketch of disposal system on
Mocksville.
Signed: ljee' La�
Septic Tank Contractor
back of sheet and mail to Health Center,