P10868 No Creek RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
i10 : of Bedrooms _ R Date 16-g-4
permit is granted to for the installation of a septic tank ..
at the residence of , A , (34&t2 -L- � Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. ub
Md.nufacturer's TJame ,�-f%� ,�=�,r�- Address���
7i
Tso� of lines---L—Width (3 G in. Total Length ft. No. of Sq. Ft.
T-Tpe or filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic
or his agent.
Date of final approval
tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been ins fled acgor n o specifications.
Signed:
Se is Tank ontractor
Note: lylake sketb'� of disposal system on back of sheet and mail to Health Center, Mocksville,
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