P1175 Jericho Church Rd DAVIE COUNTY HEALTH DEPARTMENT
JSeptic Tank) Improvements Permit and Certificate of ompletion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR 4 #- DATE j I- 4-�:- • ")(,, PERMIT
LOCATION 1r' iv �.'��Jtot" } rl• =4 ~.•� c '� �� 115
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gala 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Er Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES S" NO ❑
SITE SUITABLE YES :❑ NO ❑ !°�,•.t, '.t.
SIZE OF TANK ga1. cic
NITRIFICATION FIELD Opp sq. ft.
DEPTH OF STONE IN LINES " lutl
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY . INSTALLED BY L1, P
CERTIFICATE OF COMPLETION
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BYVVaa,.�n Date 11--1�1-'Ile
(8/16/73) *Construction must coMply with all other applicable State and local regulations
LOT AREA
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