P672 Jericho Church RdP. 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 PERMIT
LOCATION N� 672
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME p BUSINESS Cl
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK In -yo gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY "=
House Trailer 800 Gal. 400._,Sq,._Ft.
Two Bedroom House 800 Gal.1' 600 Sq.
Three Bedroom House x'900 Gal. "900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
m..
INSTALLED BY
CERTIFICATE OF COMPLETION _
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(8/16/73) *Construction must 4mply with all other applicable State and local regulations
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