P915 Jericho Church Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage'Disposal Sy tem _- G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR >` fes' 't b.J ►' �1 DATE.. �+ PERMIT
LOGAT�ON t r ' + 915
S.R. N0. '
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME _BUSINESS ❑ ,
� �+���� � wT, House Trailer- 800 Gal. 400 Sq. Ft.
NO. BEDROOMS _�r..Z_-__ NO. BATHROOMS r�i.�' Two Bedroom House 800 Gal. 600 Sq. Ft.
Three 'Bedroom House 90,0. Gal'. 900 S
: GARBAGE DISPOSAL UNIT YES ❑ NO q: Ft.
AUTO. DISHWASHER YES ( NO ❑ Four Be. room ouse 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES C+��vj, JO ❑
SITE SUITABLE .- YES C� NO [3 /j f� ,,
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft. r
-'DEPT FSTON E N LINES• 0
H 0 I N
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS-PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION. 44
RVDate n..
(8/16/73) *Construction must c y wit all other applicabhe State and local regulations
LOT AREA �•.`
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