137 Shutt Rd (2)DAVIE COUNTY HEALTH DEPARTP4ENT SEPTIC TANK PERMIT
0'arQf,
No -of dz'-eeM6- � �2, * 60 f ) Date
This permit is granted to a o ,or the installat a septic tank
at the residence of ,R,. P y, d�x r- Address c PAA, Ci
Building Contractor Address
Septic Tank Specifications: Length . Width Depth Capacity Gal. 57o -
Manufacturer's
oaManufacturer's Name -��—EAddress W;7c y ,`lr'�
No of lines widt( in. Total Length / d'a ft. No. of Sq. Ft. 2 <rb
Type of filter material Total tons used
Minimum Requirements: House Trailed Tank Cap. 800 Sq. ft. line 400
Two-bedroom house. 800 600
Three-bedroom house 900 900
No one shall install a septic tank
Officer or his agent.
Date of final approval
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: 0)ajA1n1'
C
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.