P11564 Gladstone Rd_r `4.
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DAVIE COUNTY HEALTH DEPART1,1ENT
SEPTIC TANK P=iIT
No. of Bedrooms 3 Date /;/,0 IJ�nV_
This permit is granted to �[ �J, �p/)/ '(' /cif// Cd. for the installation
of a Septic Tank at the residence of �,Q S�4�f Address /40
Building Contractor dell rJ10a2 d:Address
Septic Tank Specifications: Length Width Depth Capacity c.,6 v Gal ;.
Manufacturer's Pdame1 1 AV , j' SDA .i'' d�9�/,� �. Address ,, u /l✓ �� /%%��
No. of lines Width in. Total length ft. No. of Sq.Ft.Zc)_c�
Type of filter material J Total tons used 3 2
Minimum Requirements:
House Trailer
Two -Bedroom House
Three -Bedroom House
Tank Capacity
800
800
900
Square Ft. of Line
100
600
900
No one shall install a septic tank in Davie County without a permit from the
Health Officer or his agent.
Date of final approtal /ii— — 6 %` Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed2t—
Septic Tank Contractor
Note: I -lake sketch of disposal system on back of sheet and mail to the Health
Center in Iiocksville.
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Nf a SP �3 mes,T ..
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144
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