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Gladstone MH ParkDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PER,1IT Date'
),Amer/Occupant - To:c
lddress Address >
Building Contractor �»- Address
'Gal.Q Manufacturer's Name __,Lj ,l , Address
No. of lines Width i4g' in. Total length t 1 ,-D ft. No.
Type of filter material
Hinimum REquirements:
-r Total tons used
House Trailer Tank cap.
Two-bedroom house
Three-bedroom house
sq. ft. �'00
2�
800 Sq. ft. line 400
800 600
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 S Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
D7
Signed:,
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.
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