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P111864 Davie Academy Rd
LOCATI )N V i� �C. OWNER P F6 IS l r PRIVY: Type Number New Repaired wood concrete WATER SUPPLY: % Source�`� If well, type (Bored) (Drilled) (Dug) Distance from nearest pollution © ft. Form No. 473 (Rev. 9/58) SEPTIC TANK: ' FHA ASE NUMBER Material i H �QS hC ree Dimensions Volume date Type secondary date treatment No. of bedrooms ODc7 94� nitrification line VA CASE NUMBER filter trench Permit Number Date Approved Date Approved byt Contractor or Plumber '�3z>bne l��sSf Address �a n /T— der)Ra4Lr` Remarks ReD4�Q �� (c`SpttP _ O � l, a,DI SEWAGE DISPOSAL RECORD