1807 Fork Bixby Rdnavtp rn, �w'nir. Tay Parr -al P znnrf 1 1 X Z FY �nro anon ate., co„+o,,tio. °n )nin
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Davie County, NC
Parcel Information
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Parcel Number:
G700000118
Township:
Shady Grove
NCPIN Number:
5779091706
Municipality:
Account Number:
Census Tract:
37059-804
Listed Owner 1:
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
Planning Jurisdiction:
Davie County
City:
Zoning Class:
DAVIE COUNTY R-20
State:
Zoning Overlay:
Zip Code:
Voluntary Ag. District:
No
Legal Description:
1 LOT FORK BIXBY RD
Fire Response District:
ADVANCE
Assessed Acreage:
0.71
Elementary School Zone:
SHADY GROVE
Deed Date:
7/1975
Middle School Zone:
WILLIAM ELLIS
Deed Book f Page:
000960066
Soil Types:
GnB2
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
-
Building Value:
43320.00
Outbuilding & Extra
2960.00
Freatures Value:
Land Value:
21770.00
Total Market Value:
68050.00
Total Assessed Value:
68050.00
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Davie County, NC
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold
harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
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causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME �a I i��-� � PHONE NUMBER ��g� 9o2'�'�
ADDRESS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE vul -- al T' kL F+ ,5 t.,r -
Iris a,vtnsl�.� ►,; -is: �s� Gnu r�)
DATE SYSTEM INSTALLED 14 " ; NAME SYSTEM INSTALLED UNDER �`L�t 7",c Up
TYPE FACILITY_ iLmr - NUMBER BEDROOMS Z NUMBER PEOPLE SERVED z
TYPE WATER SUPPLY _SPECIFY PROBLEM OCCURRING R ---US Fro w.
1 �
vti G�o�s4i� — S` �� �na� �w,-- 11••- S, j i�,c�' ��ca
DATE REQUESTED g' %'
INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
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SIGNATURE OF OWNER OR AUTHORIZED AGENTX& /•A ` 2 ,r(
Rev. 1193
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AUTFJRIZATION NO: "1 ' 3 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's r % P.O. Box 848
Name: /I, L p i%t H,2--z Mocksville, NC 27028 Subdivision Name:
/Phone # 336-751-8760
Directions to property: %'f�i orf ' f`- .V - /'I Section: Lot:
•/ AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - _
Road Name: Zip: _
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
t' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Per ittee's ¢
Name: Subdivision Name:
r
�DJrections to property: ✓'"� ��+" `'. Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# -
Road Name: Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE f # BEDROOMS .2- # BATHS _L # OCCUPANTS 7 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE�J # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) —6�1. NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �E> ROCK DEPTH LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
*APPROVED EFFLUE14T FILTER* tRISER(5) IF 611 EELOJ FIHIEHF-D GRADE*
r=
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
xxxxXxnxx
.5.^.b —tY
OPERATION PERMIT r
SYSTEM INSTALLED BY: -rvl�N
AUTHORIZATION NO. OPERATION PERMIT BY: Z)kl DATE: w
11
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS
PROPERTY INFORMATION
Subdivision Name:
Dtredtions to property: Section: Lot:
= IMPROVEMENT
PERMIT Tax Office PIN:# -
Road Name: Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An ,
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE / # BEDROOMS 2 # BATHS # OCCUPANTS 7 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or 110
LOT SIZE TYPE WATER SUPPLY rt� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH`,Xt, ROCK DEPTH �:2— LINEAR FT.
nTUFu „.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
*111PPROVC1) EFFLUENT FILTER* *RIS r,�(G) IF f~=' EELMv F1141SHE- i GRADE*
l"
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
(3,35
OPERATION PERMIT J
SYSTEM INSTALLED BY: /✓/ .�...I /��/ :-� t- f
z:
K
r
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: ` W
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)