P121968 BooeDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'Io, of Bedrooms 2z _ Date / 02 -19— G Z/
:!'his permit is granted t9 7 �� for the installation of..��a DDseptic tangy:...
at the residence of Address
Building Contractor Address
Sentic Tank Specifications: Length Width Depth Capacity Gal. F-0
Manufacturer's Name Address �-
No. of lines width iTotal Length ft. No. of Sq F�
n.
Type of filter material tt-ro Total tons used
Minim= Requirements: House Trailer Tank Cap. 800 Sq, ft. line 1:0.3
Two-bedroom house 800 600
Three-bedroom house 900 90O
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 beer installed according to specifications.
// 1 )-117-
�' /- I
Signe /,/ Ay�j �/� J� Ll.� ....
Septic Tank Contractor
Note: Make sketc of disposal system on back of sheet and mail to Health Center, Mocksville,
r'�' � y
C`�
Q / � � ��