388 Milling RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PF,rtmtiil`i•
aTGo of Bedrooms �� "� Date 61�
permit is granted to �.�, ��Q S ,I � Lv � for the installa on a septic tr�_•x
at the residence of �*yr lwrzo=� Address
Building Contractor _ Address
Septic Tank Specifications: Length Width -Depth_ Capacitl�y_ Gal.
L�Mahu*acturer's Name u(' ,� l C��, , W Addressf c /�(/ C
110of lineswidth___f in. Total Length _ iy n ft. _"76. of Sq. Ft. Y
T; -pe of filter material �a,� .Total tons used
i�li.ni:inc,er Tank Ca 800 S ft. line 1+OC
Requirements: House p 9
Two-bedroom house 800 600
Three-bedroom house 900 900
No o -re shall install a
or tis awent.
Date of final approval
septic tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
I _.etiebs certify that the above septic tank has been instal ed according to specificati.ors.
Signed:i____
Septic Tank Contractor
I te: Make sketbr:; of disposal system on back of sheet and mail to Health Center, Mocksville.