P92073 Hickory HillDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEWAIT Date
JHmer/Occupant To: U,`
Address ou wl—ki C �fi 4,�—
Address u-�l of /
Building Contractor Address re ks''
Cal. ,fin Manufacturer's Name �7,Address
No. of lines Width 4' in. Total length T � ft. No. sq. ft. ?00
Type of filter material s'fCi✓ Total tons used G
Minimum REquirements: }souse 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 j �iL�'��� Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specificatio?
Signed:
Septic 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.
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