P102367 Sain RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms .3 Date 0Ii7l.- vs -3- 1,?,g
"his permit is granted to �`
z for the installation of a septic tank __
at the residence of ��y y5%,�,c�� Address
Building Contractor -,nem/ AddressR .
Septic Tank Specifications: Le h Width Depth Capacity Gal. 61 9D O
Manufacturer's Name rip % _ Address %'1 1
No. of lines�ga widthl�49'in. Total Length „7,2 -oft. leo. of Sq. Ft.
Type of filter materials Total tons used 3S _
Minimum Requirements: House Tr filer Tank Cap. 800 Sq. ft. line 100
Two-bedroom 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 c;2 Signed:
Sanitarian
I hereby certify that the above septic tank has been instal accor ing li pecifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville„
-113vS /