P91873 Hickory HillDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK
PERMIT Date
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Own er/Occupant
To,
g '% , a ,
Address � �
'
Address
Building Contra or 'k P�
Esc Address
121-a
Cal. Manufacturer's Name
j Address
No, of lines Width in.
Total,j ength
ft. No. sq.
ft.
Type of filter material
Total tons
used
Minimum REquirements: House Trailer
Tank cap. 800
Sq. ft. line
400
Two-bedroom house 800
600
Three-bedroom
house 900
900
Four , -
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1 Zat>
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.
1,T-