P42767 Madison Rd_DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
i:o, of Bedrooms Date c,� 2 /%,fie (n
chis permit is granted to /7A✓.e � % r / rJ�✓�! for the installation a septic tank-.
,rt the residence of Address /
Building Contractor //.7,P<J7— Address 4f
Septic Tank Specifications: Length Width Depth Capacity Gal. ^1 0 v _
Alariufacturer's Name Dtgy E,%� �. c -ilk Address
11o, of lineswidth- in. Total Length S ft. bio. of Sq. Ft. cl`G O
Type of filter material 5 / y /✓ f Total tons used -30
Minimum Requirements: House Trailer Tank Cap. 800 Sa. ft. line 400
Two-bedroom house 800 _._.600
Three-bedroom house 900 900
t withoui a ermit from the Health O�r-)
.No one shall install a septic tank in Davie County p
or his agent. / 1"
Date of final approval ��� % �(1 / Signed: �
Sanitarian
I hereby certify that the above septic tank has been installed according to ss ecifications.
,x%12
Signed:
Septic Tank Contractor
Note: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville,
r� 17d Q