970 Ridge Rd_ DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Eos of Bedrooms f,c v Date
...his permit is granted to for the installation of a septic tanl,,.
at the residence of a off s Address
i
�uilding Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 2oc)
Ma lufacturer's Name Address /g27( ` -i
v
Ido. of lines_width_ G_in. Total Length /a ft. 110. of Sq. Ft. zf00
lype of filter material Total tons used
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
or his agent.
Date of final approval
in Davie County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:Al_//4-" �
Septic Tank Contractor
_T1ote: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville.