P102568 Milling RdDAVIE COUNTY HEALTH D PARTMENT SEPTIC TANK PERMIT
of Bedrooms / � Date _j z 2 -
No. i 1C
This permit is granted to '� for the installation of a septic ta:�
at t}1e residence of co_ Address 4�,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal, �oo
M'an71facturer's Name��� Address417L 2�,-
1?0:: of lines width Total Length / 5'0 ft. No. of Sq. Ft(. 0
lyrpf2 of filter material �X-/���*Y,,,,,�� -a%p Total tons used /6 7
Minimum Requirements: House Traile/ Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
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 _ Signed:
Sanitarian
I 'hereby certify that the above septic tank has been instal -led acco ding toSpecifications.
Signed: G{) (%�I�
9
Septic Tank Contractor
—'-e: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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