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P71769 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT of Bedrooms Date—/'P - Z' Zoe '.his permit is granted to for the installation of a septic tank-. at the residence of U Address Building Contractor Bamrnk �g,,,'�� Address r Septic Tank Specifications: Length Width Depth Capacity Gal. —�!o o 1 41 AianufacturerI s Name �a,&LP S -,7'd , Address No. of lines_width in. Total Length Zo6 ft. No. of Sq. Ft. � oo Tyne of filter material o Total tons used A/P Minimum Requirements: House Traile Tank Cap. 8�00� Sq. ft. line Tiiool Two-bedroom house - i�00 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 Contractor Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville. / 5 -J