303 Gordon Dr (2)DAVIE
COUNTY HEALTH
DEPARTMENT SEPTIC TANK PERiMIT
I o . of Bedrooms
Date -.i-- 9
permit is granted to
h ^
�c-
for the installation of a septic tank..
the residence of
Address ("ML`zi`K4�3
at
Building Contractor 7
Address
Se-utic: T: ak Specifications :
ngth
Width
Capacity. Gal.
M
MmiufacturerI s Name +_
—
_Depth
Address---
ITr;, of lines width
in. Total
Length
ft. Yo. of Sq. Ft,
TI rme of falter material Total
tons used �10
iinimum Requirements: House Tr filer Tank Cap. 800 Sq.
Two-bedroom house 800
ree-bedroom house 900
�,...� c • vaU
ito one shall install a leptic tank in Davie County with6ut a permit
or his agent
Date of final approval Signed: _
ft, line 400
600
goo
zat�
from the Health Officer
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications
Z
Septic Tank Contractor
Dote: :Make sketh . of disposal system on back of sheet and mail to Health Center, Mocksville.,