P121567 KellerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
:av of Bedrooms %� r Date 11 -/
_'"his perm -it -is granted to w �t^cu�� for the installation of a septic tank.
zt the residence of �, �! � �/q /ge,�ddress
Building Contractor _7 Address
Septic Tank Specifications: Length Width Depth Capacity Gal.y
Manifacture.r's Name --��z G C cs Address � .cc-.f'u���•
Nc. of lines c2 in. Total Length ft. Bio. of Sq. Ft.^�
Type of Filter material Total tons used
y injd mtur Requirements: House Trailer
Two-bedroom house
Three-bedroom house
Tank Cap.800
800
900
Sq. ft. line
600
goo
No one shall. install a septic tank in Davie County without a permit from the Health Officer
o.r his agent
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Pdote: Make sketc:'a of disposal system on back of sheet and mail to Health Center, Mocksville,
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