1028 Gladstone Rd�-/G 4` S -o» a
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DAVIE COUNTY HEALTH D PARTb4ENT SEPTIC TANK PERMIT Date
Owner/Occupant e mg -ti— To
Address gix -3-2 - AP 14eAe6 Address
—�
Building Contractor Address,
Cal. Manufacturer's Name ` Address �� T
No. of lines �_ Width �in. Total length �ft. No. sq. ft.�
Type of filter material Total tons used
Minimum REquirements: House Tvailer 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 Offic
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.