634 Ollie Harkey RdDAVIE COUNTY HEALTH DEPARTMENT.
Jwner/Occupant 0iV
Address
Building Contractor
SEPTIC TANK PE -1IT Date—
To:
Address
Address
Cal.®Q Manufacturer's Name Address
No, of lines J�,Width _yin. Total length s'� ft. No. sq. ft. 46D
Type of filter material Total tons used 3
Minimum REquirements:- House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house' 800 -600
( /Three-bedroom house 90�' 900
(� n /
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval — � �_--2 ��Signed:
T— S arian
I hereby certify that the above septic tank has been installed according to specification
�iy G Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
33