2044 Cana Rd (2)LS /
DAVIE COUNTY ,GDEPARTM,Ml SEPTIC >TIANK PERMIT
of Bedroomsg Date 1,3 lc
::a.is permit is granted to for the installation of a septic tank_
at the residence of Address p,2
Buildirg Contractor Address
Septic Tank Specifications: Length Width _Depth Capacity _Gal.
/tea
Manufacturer's Name �� Address
No, of lines-width g in. Total Length��ft. No. of Sq, t.
`1 rue of fi.l.ter material io r�-o Total tons used o7s`f
�iinimmn Requi.reir_ents: House Trailer tl Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 000
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
o-1- his a.n;ent.
,ate of Final approval Signed:
Sanitarian
I hereby cartify that the above septic tank has been installed according to specifications.
Signed:
Septic �k Contractor
Mote: Make sket;;-_ of disposal system on back of sheet and mail to Health Center, Mocksville.