2172 Milling Rd (4)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms (02 %^ m: �f �la7r el/
Date
This permit is granted to for the installation f a septic tank
at the residence of �, L , �0,s �� c- Address (T %Y/o�K S ✓ �`/����✓ �e
Building Contractor Address
Septic flank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material 'Total to us'ed
Minimum Requirements: House Trailer Tank -Cap. 800 ? Sq. ft. line 400
Two-bedroom house 800 is 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:
Septic Tank Contractor
,i
Note: Make sketch of al'sposal system on back of sheet and mail to Health Center,
Mocksville.