P41866 Barnhardt - ForkDAVIE COUNTY HEALTH DEPARTi,IEPIT
SEPTIC TANK PERI"iIT
No. of Bedrooms Date
This permit is granted to c �!� for the installation
of a Septic Tank at the residence of � "-`���� Address
Building Contractor % Address
Septic Tank Specifications: Length Width Depth Capacity
Manuf acturer I s Name :23 I _ &-. Address
No. of lines Udth 3e-' in. Total length ft. No. of Sq.Ft.,1Kz3`
Type of filter material Total tons used
Minimum Requirements:
House Trailer
Two -Bedroom House
Three -Bedroom House
Tank Capacity
sM
M
Square Ft. of Line
100
600
M
No one shall install a septic tank in Davie County w ithout a permit from the
Health Officer or his agent.
Date of final approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed
Septic Tank Contractor
Note: I•lake sketch of disposal system on back of sheet and mail to the Health
Center in Hocksville.