1630 Jericho Church Rd (3) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
CONTRACTORv., s.a,•�_`r� DATE jA� �4►` PERMIT
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LOCATION t ti'i.�f,
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME tj BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS ,»f Two Bedroom House 80 1. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ * NO Q" Three Bedroom House900 G 900 Sq. Ft.
AUTO. DISHWASHER YES NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK iry gal.
NITRIFICATION FIELD 1701> sq. ft.
DEPTH OF STONE IN LINES: j �•'"
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY 7)/01f G S iT
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CERTIFICATE OF COMPLETION By ,,� 1. �
,Date
(8/16/73) *Construction must 66mply with all other applicable State and local regulations
LOT AREA
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