P111973 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Oumer/Occupant L V_ 7 To: �� ,,
Address _ Address r
i
Building Contractor 7,-"( Address
Cal. ?o Manufacturer's Name'11�,%,, Address
No. of lines _�_ Width in. Total length �� ft. No. sq. ft. �?
Type of filter material Total tons used 13
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 Offic
or his agent.
Date of Final Approval
7— % 9 - ).3 Signed :
aSaif-ftaraian
I hereby certify that the above septic tank has been installed according to specification
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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