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.
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