171 Cana RdDA`JIE ``COUNTY HEALTH DEPARTi4ENT SEPTIC TANK PERMIT
No of Bedrooms m ;/� +-- Date :z— d r %0
This permit is granted to for the installation of a septic tank
at the residence of �,q �c �nP _o hen Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. ?2:>a
Manufacturer's Name Address
No of lines width_& i . Total Length a t ft. N
Type of filter material �i rrt Total
Minimum Requirements: House TzrE ler Tank Cap. 800
Two-bedroom house 800
Three-bedroom house 900
No one shall install a septic
Officer or his agent.
Date of final approval
of Sq. Ft. • G o D
tons used CiR
Sq. ft. line 400
600
900
tank in Davie County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has been 7inslledMaccordino
specifications.
Signed:
Septic tnk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.