P92668 NeelyDAVIE COUNTY HEALTH
DEPARTMENT SEPTIC TANK
PERMIT
'1n. of Bedrooms
2 :,t .-
--Date
`_'."his permit is granted to)
for the 'nsta
—
lation of
a septic tank;_
at the rbsidence of JIL0Y W11.1
Address
J�!
Building Contractorf' ,.`
M1�._ Address�444
_
Septic Tank Specifications: Length
Width Depth Capacity Gal.
Manufacturer's Name�%"� : , ,� �, / , '� ""-
Address
Pio. of lines_sZwidth" "$° iW_ Total
Length No. of Sq.
Ft. ,3
X
Type of filter material ,,r
Total
-Total tons used
Minimum Requirements: House Trailer
Tank Cap. 800 Sq.
ft. line
400
Two-bedroom house
800
600
Three-bedroom house 900
900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval g.- j, fir, Signed: _
j Sann itarian-
I hereby certify that the above septic tank has been installed according to specifications.
Signed: V�.,r' r��`�!�• m
«0' Septic Tank Contractor
Note: Make sketbr of disposal system on back of sheet and mail to Health Center, Mocksville.
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