Talley, GlennNo. of Dedrooms
DAVM COUNTY H'Z,ALTH DEPART[MT
SEPTIC TANK PE ,-aT
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Date �w d J'
This permit is granted to ?2/a <./ tV 72- for the installation of
a Septic Tank at the residence of Address
Duilding Contractor ea U h %NCL Z lJ l !� Address -Al: -i e
Septic Tank Specifications: Length,1�,D ` WidtlL.epth
Capacity
_.,.____
A2anufacturer:s Name U/ _�� fa%��3 �'C,= tyff Address �'� ` e ` *
No. of dines tJidth �._in. Total length 0 ZV Ft. No. of Sq.Ft.i,
Type of filter material „�j[sq Z P _ S%/Ve Total tons used
Minim= rmm, Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House 800 600
Throo-Bedroom House q00 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 /.2- — /0 6 3 Si ed. u /
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Septic Tank CoAtractor
Note: make sketch of disposal system on back of. sheet and mail to the
Health Center in Mocksville.
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