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P42171 Baileys Chapel Rd
1 to DA'lIE COUNTY HEALTH DEPART;•1ENT SEPTIC TANK PERMIT Nd..of Bedrooms o2 l �lers (aK Date This permit is granted kojl for the installation of a seti 1�c t / at the residence of ©nn o e- Moe-s' e-s Address , 02 ctn c e ' Building Contractor Address Septic Tank Specifications: Length Width Depth Capacity Gal. O O Manufacturer's Name a,-,4 Address, W c .�. No of lines_ widthin. Total Length da t) ft. No. of Sq. Ft. Voo Type of filter material Total tons used Minimum Requirements: House Trailer"Tank Cap. 800 Sq. ft. line 400 Two --bedroom house 800 600 Three -bedroom -house 900 900 No one shall 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 certify that the above septic tank has been installed accord" g to specifications. Signed: ()tu� )Septic Tank Contractor Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.