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P8767 Ridge RdDAA�VVIE CO dTY HEALTH DEPARTMENT SEPTIC TANK PERMIT _s1.}, of Bedrooms ii;t '' Date "pis permit is granted to for the installation of a septic tank_ at the residence of /(�� cZpr's Address /, %yS� G f ��C� /) e_ Duilding Contractor =�(%� Address r Septic Tank Specifications: Length Width Depth Capacity Gal. 5`o0 , Manufacturer's Name Address Uo. of lines_width in. Total Length ft. No. of Sq. Ft. -ne of -filter material Total tons used minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 4o Two-bedroom house 800 600 Three -be room Ouse 00 11c one shall install a septic tank. in Davie County without a permit from the Health Officer orris agent, Date of final approval Signed: _ Sanitarian rcre1)y certify that the above septic tank has been installed according to specifications. Signed; Septic Tank Contractor Note: Make sketc::_ of disposal system on back of sheet and mail to Health Center, Mocksville. t fo ;4 I -P