P12867 Williams RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms Date /,Z --
_!his permit is granted to ' L,UL for the installation of a septic tank
at t -he residence of vlle,0 X,�utL� _ Address
SuiJIding Contractor v Address
Septic Tank Specifi tions: ngth Width Depth Ca acityGal. foo
Manufacturer's Name _ .�r�'-" Address
Ffc� of lines—, -4 width3 �, n. Total Length ^ft. No. of Sq. Ft.
ype of filter material Total tons used .30
Mini';= Requirements: House Traile Tank Cap. 800 Sq. ft. line 1+00
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
T hereby certify that the above septic tank has been installed according to specifications.
Signed:
/ F "ept Tank Contractor
Note: Make sketc: of disposal system on back of sheet and mail to He th Center, Mocksville.
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