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P102670 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT No of Bedrooms R A l/to d _ `/ Date � (p © C �� This permit is grante to �; �3>/l1 for the in tallation of.a septic tank at the residence of .,b err aS T Address :..'i �'�f a ZVI. Building Contractor Address Septic Tank Specifications: Length Width Depth Capacity Gal. o C> Manufacturer's Name 'j),q v ; P—��lJ-i , c �i9�� Address '5o/9m P No of lines �r width in. Total Length o o ft. No. of Sq. Ft. o Type of filter material '57-- -( el Total tons used / 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 Officer or his agent. Date of final approval Signed:. _ Sanitarian I hereby certify that the above septic tank has been installed according to specifications.0�4 Signed: eptic Tank Contractor Note: Make sketch of disposal•system on back of sheet and mail to Health Center, Mocksville.