P11766 Madison RdDAVIE COUNTY HEALTH DEPARTT�MNVT
SEPTIC TIdlK PE,'d- T
No. of Bedrooms 3 / Date /-/9 / 6
This permit is granted to % r r ty �for the installation
of a Septic Tank at the residence of ILK /-62rn lz�tv,d_fAddress ik. �c►-c( �?�/ ,
Building Contractor �i, r f Address
Septic Tank Specifications: Length Width Depth Capacity Lz)o Gal,;
Manufacturer' s Name
I/c; v .� c= T, e", Address
No. of lines _�_1,1idth 3<, in. Total length C' ft. No. of Sq.Ft, y-,-,'
Type of filter material 4 7'> n ; — u%c :i ) Total tons used .3 O
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer
800 100
Two -Bedroom House 800 600
Three -Bedroom House 900 900
No one shall install a septic tank in Davie County without a perrli.t from the
Health Officer or his agent. -
Date of final approval Signed: i
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 the Health
Center in Kocksvill�e%.
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