154 Flat Rock Rd (2)X117
DAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms ;��-� Date l �_
This permit is granted to it for the installation of a eptic tank
at the residence of `i o4. ra g U1rec Address
Building Contractor Addresso1-ePtn l�
Septic Tank Specifications: Length Width Depth Capaaccity� Gal. 20D
Manufacturer's Name�( a , AddressTi
No of lines_ width in. Total Lengtht. No. of Sq. Ft. SCD7—
Type of filter material / U Total tons used /
T
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Two --bedroom house, 800 600
Three-bedroom house 900 900
No one shall install a
Officer or his agent.
Date of final approval
septic tank in Davie County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.