P757 Jericho Church Rd ' nJ �h` 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 DATE DATE }`17— -^ +,". PERMIT
LOCATION T sf '---`� lc "�of i 1" �'wa +s+-`.. N? (rl
5
S.R. NO.
SUBDIVISION NAME ,,4� '9Su5" LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO.. BEDROOMS NO. BATHROOMS Two Bedroom House 80
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House, 900 - "
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 94o
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual '9 Public ❑
IMPROVEMENTS PERMIT BY 'INSTALLED BY ��a.r�� �itw •e�
CERTIFICATE OF COMPLETION By `ocNa�c% Date
(8/16/73) *Construction must corlply with all other applicable State and local regulations
LOT AREA
C.
COOlie
T �. r
D
�k0
r
t