P81963DAVIE COUNTY NZALTH DEPARMMT
SEPTIC TANIS PM-1IT
No. of Dedrooms J. Date 15- Aw /i � 3
This permit is ranted to l / <
pe g ?1g 01, P_ S4/i�' /� ��� or the installation of
a Septic Tank at the residence of &-e sA/' Address
Duilding Contractor 7771, S��%/�n.�.�' Address z_
Septic Tank Specifications: Length WidthDepthCapacity 90 Q Gal.
Manufacturer t s Name 1 � . f� �/,'� ��1� �o, Address ,' 4e
No. of lines WidthG"R—in. Total length J_5 -L, No. of Sq.Ft.��_
Type of filter material -- G, / P Total tons used r 9 z
Rinimimi Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two-Pedroom House 800 600
Three-Dedrocni House 900 900
No one shall install a septic tank in Davie County without a pe=dt from the
Health Officer or his agent.
Date of final Approval 6 3 Signed: r
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed.. 4J
ptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.