P8372 Gladstone Rd-- Cc;-/.* cis 7'o n e eW o o o l
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
JHmer/Occupant 'f ilnrr ; /Ile ('C4 s A To:
___ _
Address o�+r pJ910C 15. Address,
Building Contractor �z Address
Cal. — Manufacturer's Name �q��� ,%,�i Address
X10. of lines L_ Width 4.e in. Total length dZ ft. No. sq. ft.
Type of filter material t;�_4/0 7� �—��► Total tons used :30
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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification-
Signed :.
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.