P61369 Sanford AveAVIE COUNTY HEALTH
DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms
Date
! pis permit is granted to
for the installation of a septic tank'._
�t the residence of
_ _aq2ATress 11tz!L1A'
Duilding Contractor /�
_ Address
Septic Tank Specificatio . Length
Width_ Depth Capacity Gal.. 00
M'axiufact—urer's Name _ _ � �l
� s � Address �,� �=--
Ido, of lines_ width�in. Total
Length _Z 2 S f't, No. of Sq. Ft.
Type of filter material
Total tons used _7R U
Minis as 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.
Date of final approval
Signed:
-
Sanitarian
I her°eb' cereify that the above septic tank
has been installed accordi to specifications,
Signad:-
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville,
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