3365 Hwy 158� _� h,n. _ _
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, -Au:'loRizATiorr �rio: '� ��� � � DAVIE COUNTY HEALTH DEPARTMENT � /���`�`���� � � �
`" ' - �` nvironmental Health Section �� PROPERTY II�IFORMATION
Permutee ti ,� ��r,'�� j��(�t / P O Box 848
; Name: . �l'�� !/�':� L� � ��' Mocksville NC 27028 Subdivision Name:
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Phone # 336 751=8760
Directions to property: � ��� �.�� ' Sect�on.'� Lot:
� AUTHORIZATION FOR ' ' -
� ' +� ��,► ��� WASTEWATER . • Tax Office PIN:#
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; CONSTRUCTION ;
, , , SYSTF.M . , . . - . ' ;
Road.Name: ' Zip:�
**NOT'E** This'Authorization:for Wastewater System Construction MUST BE:ISSUED by the Davie Counry Environmental Health Secdon prior
to issuance of any Building�Rerrruts: This Fo►m/Authonzation Number should be presented to'.the Davie Counry Building Inspections ''.
Office when applying for Building Permits.:' ` `- . -. -
(ln compliaricejwith Article 11.of G.S. Chapter 130A, Wastewater Systems� Section .1900 Sewage Treatntent and Disposal Systems)
l r ' ��G y�-� ' ' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION '
� ,,,_ '' �- :.
�� � �_� '. .�`� G"�`" / r''` .� i�'" ;% ,s`' C,�� IS VALm FOR A PERIOD OF FIVE YEARS: `
ENVIRONMENTAL H ACTH SP�� . DATE ISSUED : ., ,
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***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
�' , o; ` " • - J �• 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_ #BATHS # OCCUPANTS GARBAGE DISPOSAL. Yes or No
COMMERCIAL SPECIFICATION: ;FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) _rag) "NEW SITE REPAIR SITE "
SYSTEM_ SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH/ ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: -
IMPROVEMENT PERMIT LAYOUT
"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) 6348760.
XXXXXXXXX
DCHD 05/96 (Revised)
NAM
ADDR
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
BDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 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
Rev. 1193
Parcel #: F600000026
Davie County, NC - Basic Estate Search
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Parcel #:F600000026 Account #:55205000
Owner Information
Tax Codes
PAIGE JEFFREY CECIL
MDed
ADVLTAX - COUNTY T
365 US HIGHWAY 158
FIREADVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 1.060 AC
FARMINGTON
ddress: 3365 US HWY 158
Deed Information
Local Zoning
Date: 01/1900 Book: 00128 Page: 0828
lat Book: 0004 Page: 010
Le al Description
_PIN
1.05 AC HWY 158 LOTS 2-3
5850485895
Property Values
77,6901
6,6601
MDed
26 11
110,4601
110 46
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00128 0828 01 1900 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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Davie County Web Site
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=1463170 6/8/2016