P5773 Hickory HillDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date 5-- 9— i.3
Jwner/Occupant To:
Address ��,�1��, �? _ Address M
Building Contractor p�r�a- Address
Cal. Manufacturer's Name Address
No. of lines Width in. Total length ft. No. sq. ft.
Type of filter material
Minimum REquirements:
Total tons used
House Trailer Tank cap.
Two-bedroom house
Three-bedroom house
800 Sq. ft. line 400
800 600
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 installed according to specification
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.