P72470 Pine Ridge RdDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
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No of Bedrooms 1174 1(le-c Date j k / o -z 20
This permit is granted to for the installation/6f a s tic tank
at the residence of Address
Qn„�5,�'ok ps Address
Building Contractor Address gr o
Septic Tank Specifications: Length Width Depth Capacity Gal. 91DO
Manufacturer's Name �.cp �-,L &, Address
No of lines_ width n. Total Length eft. No. of Sq. Ft. E6-0
Type of filter material Total tons used / o"Z
Minimum Requirements: House Tr ler Tank Cap. 800 Sq. ft. line 400
Two -bed oom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
55eptic'Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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