P7770 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 1:-& Q le l e y— Date � — / — ) 0
This permit is granted to �Gu ' S',T, Ca. for the installation of a septic tank
at the residence of Address
Building ContractorU� Address�� q,2
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name /)1!9,1 11 -P Address ,2EI, X ;'J7
No of lines_ width_,Z(�'in. Total Length /o b ft. No. of Sq_ . F �-edD
Type of filter materialTotal tons used
Minimum Requirements: House Trai r 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
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:�s't'
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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