P62171 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT- SEPTIC TANK PERMIT
No of Bedrooms i Date
a ion of a se is�t�This permit is granted to for the insta
at the residence of Address
Building Contractor Address
Septic rank Specifications: Length Width Depth Capacity Gal. ��94sv
Manufacturer's Name 7, Address
No of lines I widths^Gin. Total Length ft. No. of Sq. Ft. yap
Type of filter material Total tons used o?4
Minimum Requirements: House Trai r Tank Cap. 800 Sq. ft. line 1+00
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 installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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