P121868 Green Hill Grocery & ServiceDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'io, of Bedrooms Date /6L- If" --65e
Thi. �pe�r�mMie
granted tot�t.�=Q��', for the installation of a septi c tack
ati'ee of Address _
Building Contractor`� > _�� Address Ms' -IML ,
Septic Tank Specifications: ength Width Depth Capacity Gal. R.O_
Manufacturer's Name 34'� Address
No. of lines__jwidth__.�Lin. Total Length /oO ft. Uo. of Sq. Ft. Xoo
Type of filter material # "p Total tons used
M-1nimum 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 ins ailed according to specifications.
Signed: l^� - -
Septic Tank Contractor
?'tote: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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