P11471 Lybrook RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Al — .5— Date //— �z -- %/
This permit is granted to aq.5:�pj, for the installation of a septic tank
at the residence of L 70 6, I-VIVe Address /F / 176laq.,rc e f I GD)
Building Contractor �SeQ r" Srr�.'7{r�t Address 7� 1, �ardQxc e
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines_a_ width in. Total Length ft. No. of q. Ft.
Type of filter material Total tons used
Minimum'Requirements: House Traijzr Tank Cap. 800 Sq. ft. line 400
Two --bedroom house 800 600
Three-bedroom house 1900s 900
a .. Jalto? No one shall install a �'eptic tank in Davie County witout a permit from the
Officer or his agent.
Date of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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