Shore, RDNo. of Bedrooms
This permit is g ranted "to
DAVIE COUNTY HZ- ALTH DEPAR LENT
SEPTIC TANK Ph -U -7 1T
Date _ S--13—
for
-13
fo-r the installation of
a Septic Tank at the residence -of _,.s Address�,��'�,
Duilding Contractor Address
,_septic Tani: Specification : Length .Tidth Depth Capacity Gal,
r —
11anufacturerts Name _ Address
No. of Lines 2:1,74 I�idth in. Total length Ft, No. of Sq,Ft. -_9
s
Type of filter material j- —C.? Total tons used !�
Kinin u a Requirements: Tank Capacity ,Square Ft. of Line
House Trailer 800 400
Twc-_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 l —G Signed: �L
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed f zo�� ,► _ � /•r
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Iiocksville.