235 Madison Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
!o, of Bedrooms 15/ Date 3r / i -G
=.his permit is granted to KI)i e �%� ��,�1� for the installation ofa septic tank__
st the residence of Yh D1d k We ns akL Address
Building Contractor,e.4,✓G 'eA7' Address Cc,,
Septic Tank Specifications: Length Width Depth Capacity Gal. �a
Aianufacturer's Name c7r9u Address
1o, of lines ) width_a,� in. Total Length ft. No. of Sq. Ft. a
Type of filter material 5 Total tons used 2 -,7-,, ,✓ S-
14'lnimum Requirements:
No one shall install a
or his agent.
Date of final approval
House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 0
Three-bedroom house 90
septic tank in Davie County without a permit from the Health Office
Signed:
Sanitarian
1 hereby certify that the above septic tank has been installed accor 'ng to ecifications.
Signed; %?'t�� w
Septic Tank Contractor
Note: Make skete of disposal system on back of sheet and mail to Health Center, Mocksville,