P62867 Penniger - CooleemeeDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK SIT
of Bedrooms Date 2 '
"his permit is granted to for the ir_sta<-ation of a septic tank._
zt the residence of rz� `wc ,. Address _tum
Building Contractor 7� ,� _(%(� Address
c
Septic: Tank Specifications: Length Width ^_Depth Capacity Gal. o0
Manufacturer's Name k Address ��-
I,Io., of lines ^_width 3 6vin. Total Length 3 oDft. No. of Sq. Ft. '900
T1 pe of filter material^�_44 lo Total tons used 3 D
141.nimi:m, Requirements: House Tr,ziler Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 goo
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 "Tiereby certify that the above septic tank has been installed according to specifications.
Signed: q_lta4 'U
6�Sept.X Tank Contractor
Note: Make sket:cw of disposal system on back of sheet and mail to Health Center, Mocksville.