P81171 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 1 ra; e r J ` C Date ���.4
This permit is granted to t .n for the installs ion o a septic tank
at the residence of // Address 1
Building Contractor��Address
Septic Tank Specifications: Length Width DepthCapacit y Gal. a
Manufacturer's Name ��_ Address $4 f,
No of lines width %.Z( Total Length _,(33Zft. No. of Sq. t.m�
Type of filter material ��Total tons used
Minimum Requirements: House Trai r Tank Cap q'800 Sq. ft. line
Two --bedroom house -00 600
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: J�/ , C.
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.