P81568 WhitakerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT _
r� Date
.f. of Bedrooms �� /J;___
`1. ; septic t
permit is granted to 'r1 c-'.- C , (� o ,- for the install ion of a �;. 'a
w1. to.e. residence of Address
Buy tiding Contractor�fr'l c %� ` �� ` --
Address
Scptic Teck Specifications: Length Width h DeptCapacity Gal.
1, an-fa.cturer's Name Address
l
llo: of lines --/—Width__Jfk . Total Length _.G q i ft, So. of Sq. Ft.
riJrpe of filter material. L u, �_.,� Total tons used O
Mlniiaua Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100
Two-bedroom house 800 600
Three-bedroom house 900 900
Pio on: shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval i Signed:
Sanitarian
I hereby certify that the above septic tank has been Inst ed accordi to s cifications.
Signed:
L�
Septic Tank Contractor
il to Health Center, Mocksville�
..:rte: Make sketbh of disposal system on back. of sheet and ma
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