229 Milling Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT ' ,/
Uo, of Bedrooms \ 11 Date 3 -;2 /—9 ?/ _
This permit is granted to nen c e), /,�a ro e for the installation of a septic tank. .
at the
l/g
�s�7teeos11;�l'x assn rcl; Address 1(2
Building Contractor -,< Address _
Septic Tank Specifications: Length Width Depth_ Capacity Gal. c!OD
Manufacturer's Name aLaD41 � AddressC
Id
o.. of lines width in. Total Length ft. �I . Ft. (olYo
� q _.
Type of filter material Total tons used
Minimum Requirements: House railer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 (:0:13
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 installed according to specifications.
Signed- -f�
Se is Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center,. Mocksville.
j
.�.�-'--�'II1 �
�.1 1 v
Jai� � ���-