P71770 Cedar Grove Church RdDAVIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms l le — e r Date �--/ % — ) e
This permit is granted to Qy,bpn F/A a for the installation of a septic tank
at the residence of „jI ak-Az Address /a
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.T a a
Manufacturer's Name Address
No of lines_ width_,.j_44in. Total Length [?Xft. No. of Sq. Ft. baa
Type of filter material Total tons used % fr
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.