P102070 Liberty Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms c5Z Lha ' /I'
Date l,0 - /2- -
iO
This permit is granted to �r,c�,n,7 13
lK's for the installation of a
septic
tank
at the residence of
Address S- /yo
Building Contractor
Address
Septic Tank Specifications: Length
Width Depth Capacity
Gal. 0 D
Manufacturer's Name�j 00
Address IF3 '�-
No of lines width (yin. Total
Length a o oft. No. of Sq. F .
Type of filter xaterial -C& 9
Total tons used o7/
Minimum Requirements: House Trailer
Tank Cap. 800 Sq. ft.
line
1+00
Two-bedroom house. 800
600
Three-bedroom house 900
900
No one shall install a septic tank
Officer or his agent.
Date of final approval
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.
Signed: Alltad-
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.