P62772 Gladstone Rd—� R t�/ / / — n rI / e7
DAVIE OUNTY 77,6
LTH DEPARTMENT SEPTIC TANK PERMIT Date
O�,mer/Occupant 'cn0n ckU/ �� _ To:(�
Address F'f1 Address
r
Building Contractor ��>qc[� 11c�h �`�n� Address
Cal. M0 Manufacturer's NameeAddress i
No. of lines _ Width �in. Total length � a LSA ft. No. sq. ft. 'o o
Type of filter material � _ Total tons used ?p
Minimum REquirements: House T ailer Tank cap. 800 Sq. ft. line 400
600
Two-bedroom house 800
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. CiE�< t__�
Date of Final Approval A —2 �_ Signed:
S itarian
I hereby certify that the above septic tank has been installed according to specificatioT
Signed: .�d�-
Septic T nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.