173 Wall St (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date I � --x,13 -- (-Z'. l
This permit is granted to _-,;��.cx S 7`, c Por the installation of a septic tank
at the residence of ii _ Addressn1r��/
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines_ width �,e in. Total Length ;ft. N
Type of filter material - Total
Minimum Requirements: House Trailer//Tank Cap. 800
Two-bedroom house 800
Three-bedroom house 900
No one shall install a septic tank
Officer or his agent.
Date of final approval
. of Sq. Ft . 2&—,''
tons used civ
Sq. ft. line 400
600
900
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:�GC:h
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.