P755 Jericho Church Rd DAVIE CO::J;j,*HEALTH DEPARTMENT
`ku (Septic Tank) Improvements.Permit and,Certificate of Completion
�P (Ground-Absorption Sewage Disposal System - G.S.. Chapter 130-Article 13C)
OWNER OR CONTRACTOR — *?A-�1 may,din�,� DATE M-7-7f PERMIT
LOCATION _ auA7--01A C4 c'3+ ,�� y LQ.rr - w.� ly.n.�e lo Lcr-t- NO 755
S.R. NO.
SUBDIVISION NAME o , Ain. 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 800 Gal. Ft.
GARBAGE DISPOSAL UNIT YES [:3 NO ❑ Three Bedroom House OO Gal 90 �SFt
AUTO. DISHWASHER_ YES ❑ NO ❑ Four Bedroom House al. ` 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
CERTIFICATE OF COMPLETION
By— Date�a DatefTQ
(8/16/73) *Construction must 'ply with all other applicable State and local regulations
LOT AREA
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