108 Cedar Forest Ln Lot 3 DAVIE COUNTY HEALTH DEPARTMENT
` (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR ' ' DATE PERMIT
LOCATION t V:O'4 r. aCy`�1r. �t 4U1" l3- N? 054
S.R. NO.
SUBDIVISION NAME �.'z, r ;ti: �i.-x LOT NO. SECTION OR BLOCK NO.
HOUSE Q` MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. 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 ❑ 3 _ 12.7
SITE SUITABLE YES [3NO [3
SIZE OF TANK 1 % i► gal.
NITRIFICATION FIELD sq. ft. 44__ t4
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑f Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF OF COMPLETION By a_ Date _Z'fid
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
4— 2161
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