P112268 SpeerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
_i o, of Bedrooms 1 Date d-.2 a -- 6 3
":'his permit is granted to F• �u � (''�— �. ,.n for the installation of a septic tank..
at the residence of r_ �,� -
Building Contractor Address _
Septic Tank Specifications: Length Width Depth Capacity _ ----_Pal.
Manufacturer's Name ` �-� - �o t%� Address�,���ti%u� awn
No. of lines cq width in. Total Length ft. ?io. of Sq. Ft. �.
11ype of filter material Total tons used 6,<«' Who
/ v
Minimum Requirements: House Trailef� Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house `�9} OQ— 900
i _U )
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-
Signe GLS Septic Tank Tank Con ractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.