P102871 Cherry Hill RdDA?IE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date v2 ?1, 1Y %
This permit is granted to Gina s for the installation of a s ptic tank
at the residence of Address /�� ,/ ` Cr
Building Contractor ` Address
Septic Tank Specifications: ength Width Depth Capacity Gal.got)
Manufacturer's Name `6C,,-� , i Address �e , X//�
No of linesL width in. Total Length 67.d ft . No. of Sq. Ft. 6 60
Type of filter material io Total tons used o2f
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 bee4italledd according to
specifications.
Signed
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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