1052 Greenhill RdDA`lIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No'of Bedrooms \3 Date
This permit is granted to ` S!�%idbx for the installa
at the residence of 1 Address en
Building Contractor r / Address
Septic Tank Specifications: Length Width Depth Ca
� I S�
c
ty Gal. D
c ^�
Manufacturer's Name Cd) i Address
No of lines_ width in. Total Length 30tlft. No. of Sq. Ft. Zo20o
Type of filter material Total tons used '?
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
poo 1,5J.Do
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: &445g� eo Te
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.