608 Boxwood Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
:'o, of Bedrooms 7,L Date
permit is granted to for the installation of a septic tank..
at the residence of ✓ ^ `� �''rs v-r Address
Builu g Contractor Address
Septic Tank Specifications: Length _Width Depth Capacity__ Gal.
lanufacCurer' s Name �i��;a Addres` ai=l �1 sJr
Ido; of. lines—/--width 26r in. Total Length bio. of Sq. Ft. d
U,rpe of falter material �C ' Total tons used
14J.ni:anm Requirements: House Trailer Tank Cap. 800 Sq, ft. line 100
Two-bedroom house 800 600
Three-bedroom house 900 900
No one sh!a,ll install a septic tank in Davie County without a permit from the Health Officer
or his agent,
Date of final approval � � Signed:
Sanitarian
I hereby ..ertify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
i`tote: Ylak.e ske'b"- of disposal system on back of sheet and mail to Health Center, Mocksville.