P754 Jericho Church Rd DAVIE COUNTY,HEALTH DEPARTMENT
�p (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR 0 TRACTOR DATE /0• '7•�.�" PERMIT
LOCATIONr+ , . ° 754R 4
S.R. N0.
SUBDIVISION NAME zpc )f*N4 'IS 04 LOT NO. SECTION OR BLOCK NO.
HOUSE ® MOBILE HOME 0 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 S Ft. 1
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House ' 00 Ga
AUTO. DISHWASHER. YES ❑ NO ❑ Four Bedroom House 00 Gal. 1200 Sq. Ft.
AUTO, WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK. gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN.LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY (uN L+�'�►�`.arc��' .
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must co ply with all other applicable State and local regulations
LOT AREA
Ott
151
F
1 � �
1
ago X3 _