3771 Hwy 158 Pernittee's -�'" DAVIE COUNTY HEALTH DEPARTMENT
Name: r /�(�l� �.f�/" C Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
�rS
Directions to property: f- Mocksville NC 27028 Subdivision Name:
—
-1 Phone#:336-751-8760 . Section: Lot:
AUTHORIZATION FOR
y WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
1 1
AUTHORIZATION NO. 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 FoniVAuthorization 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)
i ***NOTICE***THIS AUTHORIZATION FOR W TWATER CONSTRUCTION
IS VALID FOR A PERIOD OFYEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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) NEW SITE REPAIR SITE_ �
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH/ LINEAR FT4e3 '
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT } ./
l /
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEP TME FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTA LATI N.TELEPHONE#IS (336)751-8760.
. - l
OPERATION PERMIT /J . _ •
SYSTEM INSTALLED Y: L
�OX3�g`
AUTHORIZATION NO. �/ OPERATTON PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBE ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD O TIME.
DCHD 02/02(Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME �✓�- ��— S PHONE NUMBER / .3-C 7
ADDRESS-:3-7-7-1 .5 SUBDIVISION NAME
lel.o C�CX'L LOT #
' DIRECTIONS TO SITE �� c�°-ds �� �O `=-Ss' sn-• "�. CZ '� `'�`' '
o ✓ �r n o,,,,L jo• ,, it- a--�l�wt � f�lC -�-rFti /�.�.... � U
DATE SYSTEM INSTALLED 3' NAME SYSTEM INSTALLED UNDER �r/`�- �a -6dr 4S57 4&eo
TYPE FACILITY NUMBER BEDROOMS -� NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING -�• .�+--x--�� M
I;
�L 'L ••s.s ens_
DATE REQUESTED 1 Z d 2 INFORMATION TAKEN BY_ l
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
v
Parcel#: E600000023 Page 1 of 1
oP�r�
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Parcel#: E600000023 Account#: 21455000
Owner Information Tax Codes
E771
RSE IVA NELL M ADVLTAX-COUNTY TA
A US HIGHWAY 158 FIREADVLTAX-FIRE TAX
CKSVILLE NC 27028
Property Information Township
nd(Units/Type): 4.200 AC FARMINGTON
ddress: 3771 US HWY 158
Deed Information Local tonin
Date: 12/2003 Book: 2004E Page: 0027
Plat Book: Page:
Le al Description PIN
14.249 AC HWY 158 5851736142
Property Values
Building: 123 59
BXF:
Land: 50 45
Market: 174 04
ssessed: 174 04
Deferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00071 0396 05 1964 WD Unqualified Improved 0
00390 0259 10 2001 WD Unqualified Improved 65,000
2004E 0027 12 2003 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1472235 6/14/2016