P71273 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Oamner/Occupant /�c s r �-� < <� To : C�� .� /-
Address dS lon Kdf _ Address /
Building Contractor �Address
l/O anufacturer's Name PCal.
Address
No. of lines Z_ Width _�� in. Total length ift. No. sq. ft. 9 pp
Type of filter material ^`�� Total tons used �7�
?Minimum REquirements: House Trailer 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 Offic.
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
gSigned: C�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.