P641 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)
OWNER OR CONTRACTOR 0 RJ'_.,,5n i At tj DATE f� ]�`• ��PERMIT
LOCATION st b it etR [7' + d • 6,+Va� s � � t .�NO 6 41
• 924 10 S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO WOO' Three Bedroom House j 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES0 13SITE SUITABLE s YES [ NO ❑
SIZE OF TANK Gw+ gal.
NITRIFICATION FIELD `� sq. ft..
DEPTH OF STONE IN LINES_: � . level vw py',e
11 / •
WATER SUPPLY: Individua Public 13
IMPROVEMENTS PERMIT BY � . INSTALLED BYe"
CERTIFICATE OF COMPLETION By L Date lo7^a�_, �S
(8/16/73) *Construction must c ly with all other applicable State and local regulations
LOT AREA gS 2-gS
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