1662 Jericho Church Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR —�n�.�.,. r.* .� DATE + 1%?"7.5i PERMIT ,..,._....—
LOCATION �,��• „ . k� N? 592
- S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑ ,
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS Is NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE .DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 90x„1. 900 Sq,_ t.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House /riToO G 1 1200, Sq. Ft!
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: �
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY � srrl C', :1. .
CERTIFICATE OF COMPLETION By Date /o- 16 7f
(8/16/73) *Construction must comply Uith all other applicable State and local regulations
LOT r AREA S' S}t'y., S1r.w1 cX
i
*7o
�-f
N