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P62967 Baltimore RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT o. of Bedrooms Zig Date d J M2 This permit is granted to for the installio�a septic tank'__ at the residence of �- - Address Building Contractor Address Septic TanX Specifications: Length Width Depth Capacity Gal, Manufacturer's Name _ , ,� r-- y0p Address � �� . No., of lines— jwidth in. Total Length ft. 0. of Sq. Ft. _ _- Type of filter material ijiinimtu n Rl equirements : No one shall or his agent,, Date of final House Trailer Two-bedroom house Three-bedroom house Total tons Tank Cap 00 900 used Sq. ft. line 400 00 900 install a septic tank in Davie County without a permit from the Health Officer approval Signed: Sanitarian I hereby certify that the above septic tank has been inst led according to C ecifications. / aeeg 'Signed: L� L---� _ j Septic Tank Contractor Note: Make sketbL of disposal system on back of sheet and mail to Health Center, Mocksville, -2 c. �y ©�.