P41367 Campbell RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
., of BedroomsCQ _ in iac � Date 10( �-1,3 — 6%
:.:his permit is granted to . 11,a t r' e for the installation of a septic tr,nU
st the residence of o�4me Address ' m �rr���E�
Building Contractor it Address
Septic Tank Specifications: Length _ !a" Width .3' Depth .5�� _ Capacity_ Gal..
Manufacturer's Name To Bu i Id &;Mse/-f Address_
/Do'
Tdn. of lines 3 width YTotal Length to o ft. 27o. of Sq. Ft. fD®
Type of filter material Total tons used _
ainimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house /9001 90G
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval �r Signed:
Sanitarian
i hereby crtify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbf of disposal system on back of sheet and mail to Health Center, Mocksvilleo/
.0