P5768 Riviera Homes BldgDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Tlr^. of Bedrooms Date
'l :lis permit is granted to ✓�'�w L�¢i• for the install j on f a septic t�:_:
at the r;-sidence of p Address
Building Contractor 14 l_-c%,_Address
Septic Tank Specifications: Length Width Depth Capacity Gale
lMar,ufanturer' s Name G_: Address1
11o, of lines width1in. Total Length _ O D ft. ?Yo. of Sq. Ft . '9
lYpe of filter materialiD �y 4yy>Y , Total tons used SO _
i..n:`tmu_a Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall
or tis agent.
Date of final
install a septic tank in Davie County without a. permit from the Health Officer
approval — Signed:
Sanitarian
11_ereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic —Tank Contractor
Note: Make sketbIl of disposal system on back of sheet and mail to Health Center, Mocksville.
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