P916 Jericho Church Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapt�gr 130-Article 13C)
OWNER OR CONTRACTOR t d t,`: 4 DATE PERMIT
LOCATION +.� �? �-: +C NO 916
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME F3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ( '�' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YESNO ❑ Four ,Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ( NO ❑
SITE SUITABLEYES ( NO [3SIZE OF TANK gal.
NITRIFICATION FIELD -)��fj) O t4 i'V sq. ft.
DEPTH OF STONE .IN LINES '"'
WATER SUPPLY: Individua ❑ > Public
INSTALLED
IMPROVEMENTS PERMIT BY �: �fi+.�:.-. -��.�,�.,r •
CERTIFICATE OF COMPLETION
By Date -2 3 `2
(8/16/73) *Construction must co y with all other applicable State and local
r regula+�trions
LOT AREA .1.►'13 ' Cj, •� 11� �+'-r
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