P51570 Cedar Creek RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms/ le
Date
This permit is granted to ���
for the installation of a septic tank
at the residence of
Address
Building Contractor
Address t
Septic Tank Specifications: Lengthy Widthbepth Capacity Gal._1 5'0 0
Manufacturer's Name roG
Address�cuJe 9 eL4 Ila
No of lines width, 1 in. Total
Length ft. No. of Sq. Ft. 00
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 according to
specifications.
C L
Signed: cST' , mac.
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.