2384 US Hwy 64 W Lot 1ga UA7Yt d 3d as #6vy (Pel W
Y DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms -7 Date
j This permit is granted to for the in allat osept c tank
at the residence of _ nc Address r/ . e r �'4r� aC1TaVAeN1C
Building Contractor Address
Septic Tank Specifications: Length_ Width Depth pa i _ Gal._
Manufacturer's Name�Q,uc� d i/ i•�a Address
No of lines[_ width—""in. Total Length Q i�ft. No, of Sq. Ft.
Type of filter material Total tons used.1�%T�
Minimum Requirements: ouH se�Trai r Tank Cap. 800 Sq. ft. line 4o0
tl (Tivo4edr om house 800 600
L i Three=be$room �iousg 900 900
8 l���.� Y
No.onC shall install a se ticltanlr_iril AiTee Count without a permit from the Health
Officer or his'agent, �' 1
Date of final approval'yj Signed: _
j f { Sanitarian
I hereby certify that the}above.septic tank has been installed according to
•� specifications. 1Oa
\ ' Signed: 404
Septic Tank Contractor
Note: Make'sketch.o&i'posil system back.of sheet and mail to Health Center,
Mocksville.
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