P92167 Milling RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
17,
);: of Bedrooms Date 9 ,,2/- 6
"ni., permi.t is granted to9 &Z a, s , f { �Ot for the installation of a septic tank
-!Ln
ank_.
at -the residence of*
Q.�t �
Building Contractor Address
Septic Tank Specification Length Width Depth Capacity Gal. 2 c;m
Manufacturer's Name Address • -t--
Ido,. of lineswidth 7�in. Total Length ft. No. of q. Ft. Za'a
Ty--pe of filter materialrte- Total tons used /.
Minimlzm Requirements: House Wailer Tank Cap. 800 Sq. ft. line POOOO
Two-bedroom house 800
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval / 6 Signed:
Sanitarian
hereby certify that the above septic tank has been installed according %tto� specifications.
Signed:����-�2
Septic Tani: Contractor
Note: Make sketcl-. of disposal system on back, of sheet and mail to Health Center, Mocksville.