P120 Jericho Church Rd 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 F Aw " r rl r tda k d j DATE 41,,)3-71P PERMIT
LOCATION, (i 'SAAl'ro ��° c)0 t �) Noto
No �. 120
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE M MOBILE HOME M BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House ,8, -GaJ, 6 q--Fx.,
GARBAGE DISPOSAL UNIT YES ❑ NO ( Three Bedroom House S F
AUTO. DISHWASHER YES .❑ NO Four Bedroom House ! 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YESNO '❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANKgal.
NITRIFICATION FIELD ' sq. ft.
DEPTH.OF STONE IN LINES: ,
WATER SUPPLY: Individual .. Public ❑
IMPROVEMENTS PERMIT BY •INSTALLED BY
CERTIFICATE OF COMPLETIONBy ,� } ct'-; Date w
(8/16/73) *Construction must omply with all other applicable State and local regulations.
LOT AREA
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