P71671 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date L� c
This permit is granted to for the installation of fa septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft No. of Sq. Ft.
Type of filter material Total tons used
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
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 Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.