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115 Salem Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT 'No. of Bedrooms Date This permit is grant to t for the installation of a septic tan,; a;, the residence of 1 Address Building Contractor Address l Sentic Tank Specifications: Length Width Depth Capacity Gal. �a _ Manufacturer's facturer's Name uZy S 21 �;, Address--/?-' ' K 11�( No., of lines width e-/�in. Total Length _/ D z) ft. No. of Sq. Ft. 'lupe of filter material %� Total tons used M n."mimi Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100 Two-bedroom house 800 600 Three-bedroom house 900 900 "To one shall install a septic tank in Davie County without a permit from the Health Officer or his agent. Dote of final approval Signed: Sanitarian hereby certify that the above septic tank has been installed according to specifications. Signed _ T= 142, 2 Septic Tank Contractor No -.es Make sket.zh of disposal system on back of sheet and mail to Health Center, Mocksville. __ _ - ©.lT _ _ ____ ----` � / ,