413 Potts Rd (3) DAVIE COUNTY HEALTH DEPARTMENT
^`y (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR S) DATE l �t • '7.'J PERMIT
LOCATION N? 449
S.R. NO. 1676
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer _80D•.-Ga.l. 40Q..Sq...._F...t,
N0. BEDROOMS ,y N0. BATHROOMS Two Bedroom House {r8QQ_G.a-1-: ° 6 0 OL Sq F
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House X300 Gal. DU 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 AP gal. 4A,� �-• `NJ" � "
Z
, I..l.�'v r[.,,
NITRIFICATION FIELD sq. ft. y „.Lt
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY c �•L 'r
�! c.. 141} INSTALLED BY
CERTIFICATE OF COMPLETION By Date oZ—/3
(8/16/73) *Construction must &bmpiy with all other applicable State and local regulations
LOT AREA
r
Ci
r „•