P11670 Cedar Creek Rd,... __
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DAVIE COUNTY HEALTH DEPARTIMNT SEPTIC TANK PERMIT
No of Bedrooms 3 Date // — ee— %-o
This permit is granted for the installation of a septic tank
at the residence of Address
Building Contractor s Address /N, '� 1 Dc�.e .
Septic Tank Specifications: Length Width Depth Capacity Gal. O
Manufacturer's Name i�c%i Address y-�,
No of lines_ width 17< Total Length a ft. No—of Sq. Ft. 2 J2
Type of filter material Total tons used 340
Minimum Requirements: House Trailer Tank Cap -.___80O Sq. ft. line 400
Two-bedroom hous e 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.
Signed: J_Qjvzll� ae
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.