P52268 WilliamsDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
sin. of Bedrooms I/La�.(�-,Date
spermit is granted to for the irstallat6on of a septic ta__
at the residence of C D Adaress a _
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity_ Gal, O
Manufacturer's Namej2.c•_ �0_ , L, M Address_
PIo of lines—L width yin. Total Length _ yp ft. No. of Sq. Ft . vv,
Type of filter material ����,�%l.-�;�,�t„{„ S ��,�Total tors used
1;14 Requirements: House Trailer / Tank Cap. 800 Sq. ft. line =4()
Two-bedroom house8� 00 50G
Three-bedroom house 900 9Q0
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
Y here -by certify that the above septic tank has been installed according to cxl)ecifications.
Signed: 0-;1� J�-�- /
Septic Tank Contractor
d;.;te° Make sketc of disposal system on back: of sheet and mail to Health Center, Mocksville.
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