P102468 Sain RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
e), of Bedrooms Date /D —6
C
inis permit is granted to for the installation of a septic tank;_
at the residence of / %�e. !,..;, Address
Building Contractor_ ���;� , ��Address
Septic Tank Specifications: Length Width Depth Capacity Gal. ry db
M=ufacturerI s Name dam' LAIQ 's Address /a'Y. X
`, t
No.. of lines% width �5K in. Total Length _L_�?R_ft. Uo. of Sq. Ft. b �
Imre of filter material Total tons used
.iinimum 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 tank in Davie County without a permit from the Health Officer
or his agent.
))ate of final approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been in
according t,Q specifications.
Signed: -;-�rJj
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksviile.
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