667 Greenhill Rd (2)Ne- /70
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date oZ
This permit is granted to for the installeVpn,of a septic tafi
at the residence of ���la rdtr�gq Address T • 7,
Building Contractor , �.--`�4f�s��,� Address
Septic Tank Specifications: Length Width Depth Capacity Gal. oa
Manufacturer's Name-� S/71 Address
No of lines_ width 3_4in. Total Length -r3 Sft. No. of Sq. Ft.�.5
Type of filter material Total tons used
T
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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 Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: Qjaj Q—Z*�
eptic .T,ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.