1917 Hwy 158 I-Ko
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:-Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name C - ---'Da
te "' ^—' N2 8049
Location C\
,4
Subdivision Name Lot No. Sec. or Block No.
Lot Size -House Mobile Home Business -- Industry
No. Bedrooms ..No. Baths _� No. in Family �- _ Public Assembly Other
Garbage Disposal YES E3 NO d Specifications for System:
Auto Dish Washer YES p NO
Auto Wash Ma,:hine YES ( , NO' []
Type Water Supply --- C 013
N�
'This permit Void if sewage system described below is not installed withrn.5 years from date of issue.
This permit is subject to revocation if site plans or the intended use,change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
w
ti
Improvements permit by
'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985.
Final Installation Diagram: System Ins tied by
7 �
Q
Certificate of Completion __ Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with-,
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
y�+" 'w+ -:h: _ �r ,moi,. �.. - "- ,. ,..-_ ,,. -� .,r..a„s -�-^,y--v-a ....-y.,. i`+a- e .�F:.e"'a" -•...� �,.;_i:-:._.^' �. '. y -
DAVIE COUNTY HEALTH DEPARTMENT "``
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOT.E._Issusd in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage SystemsJ Permit Number
Name �' , � �. _— Date �_ - f� N2 8049
1 Location �_ l '�` � r�> - \ \ . _ � > >l�: V
.m.
Subdivision Name Lot No. Sec. or Block No.
C.- >
Lot Size '`5~` �' — House _ Mobile Home — Business __ Industry
No. Bedrooms --.No. Baths _j__ No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO 0' Specifications for System:
Auto Dish Washer YES ❑ NO p
Auto Wash Ma,:hine YES Q' NO ❑ � � ����
Type Water Supply
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
�c
Improvements permit by
`Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985.
Final Installation Diagram: System Ins Iled by � L
Certificate of Completion –= ---- Date
'The signing of this certificate shall indicate that the system described above has been installed-in compliance with`%
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the systemwvill function
satisfactorily for any given period of time.
i
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) / u
NAME (�,� PHONE NUMBER 6� -1 r 1V �
ADDRESS \`� 'S� `�'��°�'�l IS$ SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED ? NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �o ose NUMBER BEDROOMS NUMBER PEOPLE SERVED �-
TYPE WATER SUPPLY L o Q \ SPECIFY PROBLEM OCCURRING
DATE REQUESTED 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.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Bay.1193 ;�,
Parcel#: H500000021 Page 1 of 1
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Parcel#: H500000021 Account#:62524000
Owner Information Tax Codes
OTHROCK LEWIS F&ROTHROCK JEAN B ADVLTAX-COUNTY T
1917 US HIGHWAY 158 FIREADVLTAX-FIRE TAX
OCKSVILLE NC 27028
Property Information Township
nd(Units/Type): 9.050 AC MOCKSVILLE
ddress: 1917 US HWY 158
Deed Information Local Zoning
ate: 09/1998 Book: 00206 Page: 0130
lat Book:
age:
Le al Description PIN
19.486 AC HWY 158 5749167258
Property Values
uildin 30,06
OXF•
Land: 84 82
01
Market: 114 88
ssessed: 11488
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00206 0130 09 1998 WD Unqualified Improved 0
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All information on this site is prepared for the Inventory of real property found within Davie County. All data Is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be
consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County,
Its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1464068 6/9/2016