157 Neely Rd..
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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms aZ �47is '';11 &I �� Date �{— 3 a —20
This permit is granted to for the installation of a septic tank
at the residence of 'c y ds/�:.� .�7�'s7� Address s+o/e�;►,pe
Building Contractbr (7.04 ex
Address _It
Septic Tank Specificatiodt, Length Width Depth Capacity Gal. ''6 �o
Manufacturer's Name/l�a��: z % , �, o_ Address�,�
No of lines oris h —'_ in. Total Length eft. No. of Sq. Ft. L a-t�
Type of filter material Total tons used r
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two --bedroom h use_ 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:
"Septic Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.