P92266 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Qo, of Bedrooms 3 Date
'Pais permit is granted to 'z5a_c:e (F ,7, ecfor the installation of a septic tan)
at the residence of
_ Address
Bui iding Contractor cr ua,.� Address �7`, C( - Jfirp-���c��
Septic Tank Specifications: Length Width Depth Capacity Gal. ?00
,F- nufacturer's Name Address
I3o, of lines width Y '�' in. Total Length
Z�,rpG of filter material Total
);o. of Sq. Ft. i '9 q O
tons used
inime-z. Requirements: House Trailer Tank Cap. 800
Two-bedroom house 800
Three-bedroom house-, 900
Sq. ft. line 4o0
600
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.
,Gc.Ld Signed:
Septic Tank Contractor
rote: Hake sket!3:1 of disposal system on back of sheet and Maki to Health Center, Kocksville.