410 Calahaln Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
co, of Bedrooms � Date d, (. -( %
hi.s permit is granted to 77-di for the installation of a septic tan's__
.it the residence of Address. �''llgcG�'t1.
:wilding Contractor Qtr Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
IManufacturer's Name Address ca��
IIo. of lines_ width in. Total Length _._____ft. No. of Sq. Ft. yJv
Type of filter material Total tons used
Minim= Requirements: House Trai er Tank Cap. 800 Sq. ft. line 400
Two-bedroom house00 600
Three-bedroom house/_9-00—_—/___goof
No one shall install a septic tank in Davie County without a permit
or his agent.
Date of final approval Signed:
from the Health Officer
Sanitarian
I hereby certify that the above septic tank has been installed accordingtospecifications.
Signed:_
Septic Tank Contractor
Note: 14ake sketc'.: of disposal system on back of sheet and mail to Health Center, Mocksville.