238 Ollie Harkey RdDAVIE COUNTY HEALTH DEPARnMITT SEPTIC TANK PERMIT
No of Bedrooms 3 Date / — � — ) 071
This permit is granted to for the installation of a septic tank
at the residence of rr e-"/ a f Address
Building Contractor Tr��cj Addresso'L
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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