P111168 HollomanDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'.yo, of Bedrooms Date 1/ -
permit
/-
".I�is permit is granted to for the installation of a septic tank
' i
at the residence of ( % L� . �.:il����-�- Address /4y, > , i, (
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name (_e iLAddress !tom, y� r✓J / ,, ,
Igor of lines / width.4_�' in. Total Length ft. Uo. of Sq. Ft.
Type of filter material�Ivti Total tons used /i) -
Minim= Requirements: House Trailer Tank Cap. 800 Sq.ft. line x+00
Two-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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Se tic Tank. Contractor
Note: Make sketc: of disposal system on back of sheet and mail to Health Center, Mocksville,