P92568 Main Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
t':_ of Bedrooms c21 Date
This permit is granted to ,! p �:a� {� (_,�, � for the instal ani of septic tank_
a�3 the residence of Address
Bu -.i ;ding Contractor �/'.��_ t.e2 (a�a,r. j (.+� Address
IT
SeTrtie Tank Specifications: Length Width Depth Capacity__ % Gal. �-
.Sanuf acturer's Name -� c.� aaa"s „,.p . Address
fdo� of lines Lwidth__.__Yln. Total Length __,LjjQft. No. of Sq. Ft.
`l;pe of filter material r�1a ^77' ='fA_tl? p Total tons used
Mini�min Requirements: House Trailer Tank Cap. 800 Sq. ft. line I:00
Two-bedroom house
Three-bedroom house 8�"1
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Dato 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 sketbh of disposal system on back of sheet and mail to Health Center, Mocksville,
Llwy)
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