P446 Jericho Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements. Permit and Certificate of -Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Ar5ple 13C)
OWNER OR CONTRACTOR Te-�Cy y-�f +1(' DATE S PERMIT
LOCATION. a 1, 9 446
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS �•'` NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK Q gal.
NITRIFICATION FIELD sq. ft.
DEPTH`DF,STONE IN LINES:
WATER SUPPLY: Individual ❑ }Public
IMPROVEMENTS PERMIT BY `--
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House B,QQ--,Gal, 600 Sq. Ft.
Three Bedroom House �Q,(�,a.-:9QQ-.Sq---•Ft...,
Four Bedroom House "'1000 Gal -.,-t.1200 Sq. Ft.
INSTALLED BY%ZZtFO-4E�
CERTIFICATE OF COMPLETION By l �, Date / .3�_
(8/16/73) *Construction must com y with all other applicable State and local regulations
LOT AREA
�� tt
r;
s
Gam'
C.
f
a _
r'