P92667 Madison RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
,R), of Bedrooms 3 Date
This permit is granted to '—�� T S,eo for the installation of a septic tank.
at the residence of � � l Address
4'
Building Contractor s,,,�c,1ti Q, Address
Septic Tank Specifications: Length Width Depth Capacity Gal. S
IR
Manufacturer's Name ��u�Q c�, / , m Address
Manufacturer'sL�
i
110. of lines`.,/ width__LLin. Total Length ft. No. of Sq. Ft.
Trpe of filter material Total
tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq
Two-bedroom house 800
Three-bedroom house 900
No one shall install a septic tank in Davie County without a permit
or his agent.
Date of final approval Signed:
ft. line 400
600
900
from the Health Officer
Sanitarian
I hereby certify that the above septic tank has been instal ed according to s cifications.
Signed •
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.