P61070 Cana RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms ' nA+A / _ it _ 9 ^
This permit is granted to for the in allation of a septic tank
at the residence of / %,`fie Ae r Address /7-f, si
Building Contractor Address
Septic Tank Specifications: Length_ Width_Depth Capacity— Gal. Poo
Manufacturer's Name -� 7Address
No of lines 1 width�tal Length 43ft.. No. of S . Ft L10
Type of filter mmaterial p. Total tons used , '/_
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft, line
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 hereby certify that the above septic tank has been installed according to
specifications. � �z� �
Signed: a� &_
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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