581 No Creek Rd (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
d<o,, of Bedrooms z3 Date
`'`his permit is granted to for the installation of a septic tank .\
at the residence of C`4a� Address /: �� da .� ` 6" 6-k , i J
Building Contractor /f 4, 4�,ur »t e 7' Address r
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
IFo., of lines width in. Total Length ft. No. of Sq. Ft.
T,rpe of filter material Total tons used
Minimum Requirements: House Trailer
Two-bedroom house
Three-bedroom house
No one shall install a septic tank in Davie
or his agent.
Date of final approval
Tank Cap. 800 Sq
800
900
County without a permit
Signed:
ft. line 400
600
900
from the Health Officer
Sanitarian
1 hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
N ote: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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