525 Gladstone RdI
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEfiNIIT
Li'o, of Bedrooms Date
r"nis permit is granted to c2c ` ,� ,� for the installation of a septic tank__
at the residence of Address [f_ ���ciN,C i
Building Contractor Address 6-Wez-pae 4
Septic Tank Specifications: Length Width—___Depth Capacity Gal,
Manufacturer's Name G.1 «w` -e ,� ,! / Address
Ido,, of lines
/ width Sin.
Total Length _
eco ft.
a?pe of filter
material s
,S-(.��>
Total
No. of Sq. Ft.
tons used
G as
Mjinimuli, Requirements: House Trailer Tank Cap. 800 Sq. ft. line 100
Two-bedroom house 800;x° bO0
Three-bedroom house 90 900
No one shall
or his agent.
rate of final
install a septic tank in Davie County without a permit from the Health Officer
approval — Signed:
Sanitarian
I 'Loreby certify that the above septic tank has been installed according to specifications.
Signed:�ir
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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