664 Ollie Harkey Rd (2) 3d Of& e.
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Owner/Occupant r r o ,r— To:
Address D cks v Address
Building Contractorr4 r�_ Address
Cal. ,g op Manufacturer's Name op Address `
No. of lines Z Width �in. Total length ft. No. sq. ft.
Type of filter material Total tons used r Z
Minimum REquirements: House Tra' r 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 Offic
or his agent .
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been insta ed accorg to specif_icatior
Signed:
Septic ontrac
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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