P183 Jericho Church Rd DAVIEk1D
EALTH DEPARTMENTY�o
,
( (Septic Tank) Improermit and Certificate of Completion
(Ground Absorption Sewa�e D , �y,stem - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR S t tF � A E-3^t` Y ! P DATE PERMIT
LOCATION ; pry? *�1 ti �;,�, r O
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House +.,
GARBAGE DISPOSAL UNIT YES ❑ NO 13 Three Bedroom House C�Q�-G&O
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft..
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.'
NITRIFICATIONFIELD.FIELD. sq. f t.
DEPTH OF STONE IN LINES: ri
WATER SUPPLY: Individual PQ Public ❑
IMPROVEMENTS PERMIT BY r. {` j' yd✓s'�+... INSTALLED BY
CERTIFICATE OF COMPLETION By t/'19 Date
(8/16/13) *Construction must comply with all other apIWicable State and local regulations
LOT AREA
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