170 Milling Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
TY of Bedrooms Date
3�3t-G� _
'!!his permit is granted to for the installation ofa septic tank.. -
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a -t; the residence of , Address
Building Contractor Address
Sept�c Tank Specifications: Length Width Depth_ Capacity- Gal. _�4
Mp=facturer's Name Address -4
N �' w' 7 i T Length o a ft No. of S. F7 D o
c� of �znes�_ width n. Total ngt 3 � q _�_„
Tyype of filter material -75t-lozla' y Total tons used
M nimuin Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
I.o one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final aaproval Signed:
Sanitarian
I hereby certify that the above septic tank has been Inst led accordin t specifications.
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Signed:
SeptV Tank Contractor
Note: Make sket:e: of disposal system on back of sheet and mail to Health Center, Mocksville.
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