P091873 Hickory HillDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEW,1IT Date
Owner/Occupant To: ��; �, / &S
Address (V,� Address
Building Contrafor„�� Address A�
Cal.'- Manufacturer's Name Address
No. of lines Z Width _j_6 in. Total length ft. No. sq. ft. S,3
Type of filter material Total tons used o7 �-
Minimum REquirements: House Trailer 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 instated ccor n nI if' for
Signed:
Septi ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.