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f Penn ittee'sty� DAVIE COUNTY HEALTH DEPARTMENT
Nanier t , -� a'% f Environmental Health Section PROPERTY INFORMATION
tvo/.0 /GAGt1 P.O.Box 848
Directions to property: Mocksville,NC 27028 Subdivision Name:
✓/1,..✓ P -"" `�� r f�.fr' 1�.; J% Phone#:336-751-8760 Section: Lot:
AUTHORIZATION FOR
C�,r /?1 .. �r:�l;%�(.'r!?✓' �. �' WASTEWATER
: SYSTEM CONSTRUCTION Tax Office PIN:#
220
i%UTHORIZATION NO: A Road Name: Zip:
**NOTE**'Ibis Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This FornVAuthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
'l/ IS VALID FOR A PERIOD OF FIVE YEARS.. '
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS _49, #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 :�'el,,, ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
J
j.
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM x
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
SYSTEM INSTALLE
AUTHORIZATION NO.ja')—V 6 OPERATION 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 02/02(Revised) >
o_
f '
' DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAMEl `� �lrr-(I�h PHONE NUMBER Q
ADDRESS J I 1't-�xJ \1 ls� SUBDIVISION NAME
c� A/C LOT #
DIRECTIONS TO SITE I
01
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
�ll
n
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#: E60000009202 Page 1 of 1
oN.,z
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Parcel#:E60000009202 Account#:67828000
Owner Information Tax Codes
MITH NANCY BATES ADVLTAX-COUNTY T
172 US HIGHWAY 158 FIREADVLTAX-FIRE TAX
DVANCE NC 27006
EressProperty Information Township
:
(Units/Type): 0.460 AC FARMINGTON
4172 US HWY 158
Deed Information Local Zoning
ate: 09/1987 Book: 00140 Page: 0115
Plat Book: Pa e:
Le al Description PIN
52 AC HWY 158 5861165498
Property Values
uildin 62.00
BXF•
nd: 16,99
Market: 78 99
essed: 78,99
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00140 0115 09 1987 WD Unqualified Vacant 1
View Prooerty Record for this Parcel View Mao 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=1464546 6/16/2016