P52268 McCallisterDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PE1iikil`I'
lln: of Bedrooms L" Date a 02
li.W permit is granted to for the irstallat- n of a� e� tic tt;_
w the residence of �,it `'rt �Cct_(� = c -_-- Address %. ✓,�8-?%�i� c Gam. __r__
Y ` I
Duilding Contractor r� � .T• � -- _ Address
Septic: Tank Specifications: Length Width�Depth Capacity___ Gal.Z-)�
Ii<anufa^tur: is Name Ct-z�.�Q .� . / „ Address_
No, of lineswidth YVin. Total Length _ r,t> ft.
`,rpe of filter material .fes ins ,��, w:�u� ���_Total
No. of Sq. Ft. Z' 6�
tons used
Mini= ua Requirements: House Trailer Tank Cap. 800
Two-bedroom house 800
Three-bedroom house 900
Sq. ft. line 400
600
900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his aL nt,
Date of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to �cificafiers.
Signed: .PJ2/L �:�CJ��(/ �� "•'�
Septic Tanlh Contractor
iIote° Make sketbh of disposal system on back of sheet and :nail to Health Center, Mocksville.