P7866 RestaurantDAVIE COUNTY HEALTH DEPARTP1ENT
SEPTIC TANK PERMIT
No. e;-$edrveriis 9-�+�.,•�+:a.�c,�-?� Date to
This permit is granted to for the installation
-�-'
of a Septic Tank at the residence of /Vi ^S t J 4 e e /ter-- Address
Building Contractor Address
Septic Tank Specifications: Length /Z Width V Depth y,,:;-'6apacity 90 o Gal;
I 14r % \A16 e e (le C- 6 u; (t '7 -
Manufacturer's Name H; #-, s f -I 147 r Address
No. of lines oZ Vidth L1l� in. Total length .? / o ft. No. of Sq.Ft. .4 o
Type of filter material 41p Total tons used 30.1
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House £300 600
Three -Bedroom House 900 900
No one shall install a septic tank in Davie County w ithout a permit from the
Health Officer or his agent.
v01j Date of final approbal �% -g G Signed:l� �, i 6AP -L-c�
p Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
SignedR'm^b,1A 1?i I.f :: ,
Septic a c on ac or
Note: Make sketch of disposal system on back of sheet and mail to the Health
Center in HocksvilIe.
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