271 Gladstone Rd (2)_. . , _ ... .. . � � _.. i .._ �.. _... ..._.. ..�..:..1 t... .. ..�
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms _� Date ao
This permit is granted to for the installation -'dT a s. ptic tank
at the residence of ,`,fi r C o /Address -f-, �QCf�� c,,'//w
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._a_
Manufacturer's Name ba', p c , e, Addressl;4,
No of lines_ width in. Total Length 1p0 ft. No. of Sq. Ft. J1190
Type of filter material O 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 Inst led according to
specifications.
Signed.
LZL-1�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.