138 Plott Lnl
/ DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
I7,o, of Bedrooms � Y-- Date
`Ehis pe_mit is granted t e, for the installation of a septic tanh;.-
at the residence of oCovt i �s' Address . C2
Bui .riirg Contractor a„ Address
y7eptic: Tank Specifications: Length Width Depth Capacity Gal,
M,_nufacturer's Name �4yi� 5',T, eo , Address
of linesr�-witdth�lL3_!�in. Total Length ft, No. of Sq. Ft.e�
�yI, of filter material /D i` Total tons used
14jnilml r Requirements: House Trailer Tank Cap. 800 Sq. ft. lire1F00
Two-bedroom house 800 600
Three-bedroom house 900 900
:To one shall install a septic tank in Davie County without a permit from the Health Officer
or h �.s aaent .
Data of final approval _ Signed: _
Sanitarian
I hereby f;;rtify that the above septic tank has been installed according to specifications.
Signed: 2&�
ep c Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.