P3971 Liberty Church RdDAVIE COUNTY HEALTH DEPARTi4ENT SEPTIC TANK PERMIT
No of Bedrooms 1 )-,i ; (At ;" Date 2
This permit is granted to v,,�iJ Ab n �,�_ for the installation of a septic tank
at the residence of re<t `E.v� .'i7z Address. � 3� MCC & J;z!!�=
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._
Manufacturer's Name Address ..3
No of lines f _ width" in. Total Length Lc ft. No. of Sq. c
Type of filter material f 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
specifications.
Note: Make sketch of disposal
Mocksville.
septic tank has been installed according to
C
Signed 0) ,
Sep 'c Tank 1 o tractor
t
system on back of sheet and mail to Health Center,
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