581 No Creek Rd (4)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
7.,), of Bedrooms Date 3 -2-
L �C
:'his permit is granted -7L,���r �`��c�tfor the installation of a septic tank-
,it
ank _
;at the residence of 1: �t � �j �%v`c%L% Address the
Building Contractor �j �Lw— Address
Septic Tank Specificati s: Length Width Depth Capacity Gal. ` ZID
Manufacturer's Name Address
11c. of lines widthin. Total Length Q ft. LTO. o'f Sq. Ft.
Type of filter material cis � l D Total tons used 3
Mini.liun Requirements: House Tr ler Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three- e room oase 90 X60
No one shall install a septic tank in Davie County -�ri.thout a permit from the Health Officer
or his agent.
Date of final approval 3 o?a X Signed:
Sanitarian
I h.creby certify that the above septic tank has been installed according to specifications.
Signe
Septi<q_-1_taex Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.