1662 Jericho Church Rd (2) • DAVIE COUNTY HEALTH DEPARTMENT
- (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
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OWNER OR CONTRACTOR i�. -t -t ,�;i <, �(= DATE =/ 7 r _ PERMIT
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LOCATION �• :t �1 u f 110„ 1358
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE JM MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS f N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK /t"y10 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY AOL 1�11d c�� INSTALLED BY
CERTIFICATE OF COMPLETION By mDate ��
(8/16/73) *Construction must co ly ���
l other applicable State and local regulations
LOT AREA
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