P3568 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
'�Io� of Bedrooms T!.� -
Date ^S
This per -mit is granted tofor
^4
the installation of
a septic tan]
�i�_
a -L the residence of-1'�/'` �"°�
Address
:wilding Contractor
Address
Septic Tank Specifications: Length Width
Depth
Capacity
Monufac:turer's Name l,.lfc.c ,
Address/���B��:� ,
No;. of lines width L<S-in. Total Length
_ ft, rib.
of So_. Ft. =2"
T�rpe of filter material �5z
Total tons
used
'+; .n'LLTiln Requirements • House railer Tank Cap. 800
•
Sq. ft. line
'
x+00
Two-bedroom Ouse
800
600
Three-bedroom house
900
900
No one shall install a septic tank in Davie County without a permit from the Health Officer
o: his agent.
Date of final approval _ Signed:
Sanitarian
I hereby certify that the above septic tank has been inst fled according to specifications.
Signed: �r r
Septic Tank Contractor
?dote: Make sketba, of disposal system on back of sheet and mail to Health Center, Mocksvillc..