P8767 Ridge RdDAA�VVIE CO dTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
_s1.}, of Bedrooms ii;t '' Date
"pis permit is granted to for the installation of a septic tank_
at the residence of /(�� cZpr's Address /, %yS� G f ��C� /)
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Duilding Contractor =�(%� Address r
Septic Tank Specifications: Length Width Depth Capacity Gal. 5`o0 ,
Manufacturer's Name Address
Uo. of lines_width in. Total Length ft. No. of Sq. Ft.
-ne of -filter material Total tons used
minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 4o
Two-bedroom house 800 600
Three -be room Ouse 00
11c one shall install a septic tank. in Davie County without a permit from the Health Officer
orris agent,
Date of final approval Signed: _
Sanitarian
rcre1)y certify that the above septic tank has been installed according to specifications.
Signed;
Septic Tank Contractor
Note: Make sketc::_ of disposal system on back of sheet and mail to Health Center, Mocksville.
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