P1729 Jericho Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption SewageDisposalSystem - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR I . VV (. ("i ,�} ! (, T�( DATE / % %. PERMIT
LOCATION r''i� t,t : �iG' �`a'c!l p...,� Jj, 1 L_. ' N. 1729
a.a�• aw.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE El' MOBILE HOME BUSINESS ❑
NO. BEDROOMS 3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO 0 --
AUTO. DISHWASHER YES ❑ NO D—
AUTO. WASH. MACHINE YES ❑ NO ❑""'
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: y
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
(8/16/73) *Construction must comply
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY r -A n.,. _`
�_OV Date
th all other applicable State and loca re ations
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