P756 Jericho Church Rd C DAVIE COUNTY-,HEALTH DEPARTMENT
�� (Septic Tank) Improvements Permit and Certificate of Completion
(Groun�Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
,JNER OR CONTRACTOR 'VQ ►s►~ pk► iu�iu rr DATE /0` + XS�- PERMIT_;
LOCATION'':3rAr`z';or<t �c,c+r �. ' Rd. iu �CC--� - (=�.� �c�+sc. N9 756
cr- Cu'rlE.+. S.R. NO.
SUBDIVISION NAME �►3�• 91�,'"I Scs LOT NO. SECTION OR BLOCK NO.
HOUSE . (,� MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 80 Gal. .600 �SqFt.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 00 Gal. 900
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House Gal.
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 ❑ e
IMPROVEMENTS PERMIT BY STALLED BYi-a.,,}� �
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable .State and. local regulations
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