136 Few Acres LnDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
of Bedrooms 2 Date
his permit is granted to for the installation of a septic tank__
at the residence ofAddress
Duilding Contractor�ro.crs=c�. Address
Septic Tank Specifications: Length Width Depth Capacity Gal. �jr4s1
Manufacturer's Nameri Address
Tio, of _lines tQ_ wwidth�in. Total Length _ / SSD ft. Yo. of Sq. Ft. GOd
Type of filter material
i4li.nimlun Requirements:
No one shall_ install a
or his agent.
Date of final approval
Total tons used
House Trailer Tank Cap. 800 Sq. ft. line '1�L�
Two-bedroom house q 00 ('600
Three-bedroom house 00 90
septic tank in Davie County without a permit fromtheHealth Officer
Signed: �.
-t— Sanitarian
T hereby certify that the above septic tank has been installed according to specifications.
Signed:,
Septic Tank Contractor
Note: Nuke sketca of disposal system on back of sheet and mail to Health Center, Mocksville