P102968 Cedar Creek RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms 7i2 1 Date !n
._
` his permit is granted to -�C� �J for the installation of a septic ta: H;
-t the residence of Address
Building Contractor Address
se -otic Tank Specifications: Length Width Depth Capacity _Gal.
'Manufacturer's Name Address�jFi
!'do, of lineswidth,36 in. Total Len h r.3 eft. Fo. of Sq. Ft. O� _
Type of filter material -#7_41e3 �e� _ U �vu�. o Total tons used
+"i�.n�.m: Requirements: House Trailer Tank Cap. 800 Sq. ft. line X00
Two-bedroom house 800 600
Three-bedroom house 900 900
do one shall install a septic tank in Davie
or his agent.
Date of final approval
County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note; Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville„