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2408 Hwy 158 �, ' f ., i, , ...�-1' ;.•I 1. '_i..'f.,'. n... y • ...,.. -.....,�P ..4'.f.et .. 3.. I.a h._-v - ;s xt+4- ,a. v ... FAid ,:."'"Permittee's �,-DAVIE C UNTY HEALTH DEPARTMENT Name: ' fJ.-'�' "7� �r i`' environmental Health Section PROPERTY INFORMATION P.O. Box''848 '.Directions to property:gy08, / r%: tl. ~d� Mocksville,NC 27028 Subdivision Name: Phone#:336-751-8760 At a � 'a[/�'L Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# /{ SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 3 4 3 A 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 1 I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ✓ f i' ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISS ED RESIDENTIAL SPECIFICATION:BUILDING TYPE #`BBEIDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or Na COMMERCIAL SPECIFICATION: FACILITY Pg. #PEOPLE 1 #PEOPLE/SHIFT #SEATS C!?O�INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD>__ NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �,7 INEAR FTy2,!3Q OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: r i IMPROVEMENT PERMIT LAYOUT J . **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 (336)751-8760. OPERATION PERMIT 'O SYSTEM INSTALLED BY: 10 'I AUTHORIZATION NO.PY� 'IOPERATION PERMIT BY: DATE: **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 07102(Revised) / �' DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION y k1n°`I APPLICATION FOR I PROV MENT PERMIT(REPAIR) OM: 33 V �ll,�aod (t' rte Hope 3c„p Y nye 9 Z NAME Wl; __7 3 � � PHONE NUMBER - A DD E G d W O � SUBDIVISION NAME 7( LOT# DIRECTIONS TO SITE 1 W J P Dj ( WL14 ubs in DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING L S� DrD S DATE REQUESTED q-Z-� -()q INFORMATION TAKE 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 Rev.1/93 r r naWrid '� W btJd N4 4 f-o 6t +kQ-(#- c t 4-7nL LT� sib-. v'1s� f Y r • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION rlW-" d Q.4,fkE z APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME 1 PHONE NUMBER (=P--P x/07 7 -3 ADDRESS 7 `6 SUBDIVISION NAME LOT # DIRECTIONS TO SITE e - DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING `"�� Cdr►+-�-c-c _S' G DATE REQUESTED f y INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge.and that I understand 1 am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1193 4' a�� w..>.yww ♦ .i'r rvt r n•r�u! !I`JN',h 1. "'�3'++'.ra�71'45F��t�'.`"7iYa7yvCt^i'R ".fal?`'i;Y''4''G ta�7�•+`!s'6%ii :!'K '1`ti�W 1•y03wt� 'i'I.'—�,ba'y�i+/�>,/ �;� UP iS . DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND :CERTIFICATE, OF .COMPLETION *NOTE:Issu`ad in Compliance With Article I I of G.S.Chapter I 30a Sanita rYSewage S stems `:. �� OX all7 ��I� Permit -Number .. g y `Names t C �l/� G✓ Q Date yam_ N2 69.89 MLocation` — PSP S�yDC��r -•�,Pr'r-r`J Subdivision Name Lot No. -Sec or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms No. Baths 'No. in Family !Crr'" Garbage Disposal YES ❑. NO .❑ Specifications for`System: r Auto Dish Washer YES E] NO ❑ .._. �a 'e olel� �f Auto Wash Ma.hine YES E] NO ❑_ r��l Ov� f � -9 Type Water. Supply 4f'l *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: (0 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. or 1:00-1:30 P M M on:day of completion. Telephone Number.704-634-5985 Final Installation Diagram:• System;Installed by 7 AwCertificate of Completion _ Date 'The signing of this certificate shall indicate that thei 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 satisfactoril for an iven eriod of time. Parcel#: G500000087 Page 1 of 1 o DVV Davie County, NC - Basic Estate Search 0ov��1, Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:G500000087 Account#:36976000 Owner Information Tax Codes OPE BAPTIST TABERNACLE ADVLTAX-COUNTY T O BOX 217 FIREADVLTAX-FIRE TAX OCKSVILLE NC 27028 Property Information Township nd(Units/Type): 3.810 AC MOCKSVILLE ddress: 2408 US HWY 158 Deed Information Local tonin ate: 06/1982 Book: 00116 Page: 0649 Plat Book: Page: Le al Description PIN K.09 AC HWY 158 5840418908 Property Values uildin 613,76 BXF• nd: 49,21 0011 arket: 662,97 ssessed: 662,97 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00116 0649 06 1982 WD Unqualified Improved 0 View Prooertv Record for this Parcel View Man for this Parcel View Tax Bill Information « Return to Basic Search 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=1469132 6/15/2016 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issu6d in Compliance With Article II of G.S.Chapter 30a Sanitary Sewage Systems Via.hw&/9 12)x'�� Permit ,Number Name sd CIPI e Date z� N2 6 9.8 9 Location' — elPL oyY_ez/l��- Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths C2 No. in Family��u���r Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ „�� Auto Wash Ma:hive YES ❑ NO ❑ Type Water Supply Ki — *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. PY Improvements ermit b P *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 day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System`Installed by _ 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. aW rw� a4 a,'.s s7^. ' S--{ , �,�;,,. r 2 'LRr@ ': L �..� ,• . r 7 1/,{' i DAVIE COUNTY HEALTH DEPARTMENT `IMPROVEMENT S PERMIT AND CERTIFICATE OF COMPLETION NdTE-lssued in Compliance With Article 11 of G.S.Chapter 130a - "Sanitary Sewage Systems " �d 'e64X aJ7 /Ja,Il Permit C�Number Date �� NO C7�C?9 - Location i ice'� � Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home Business Speculation No. Bedrooms Baths CQ No. in Family f Garbage Disposal YES ❑ NO ❑ Specifications for.System: ,Auto Dish Washer YES ❑ NO ❑ Auto Wash Ma shine YES ❑ 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. i L 0 � r^ 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. or 1:00-1:30 P.M.:on day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by t' Irk� 1 ' 1: Certificate of Completion Z 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.