2203 Hwy 601NPermittee' DAVIE COUNTY HEALTH DEPARTMENT
Name: Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property: �% Mocksville, NC 27028 Subdivision Name:
Phone #:.336-75178760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION "
.2113
-,7
:AUTHORIZATION NO: A RoadWaZip:"'
**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 Pen-nits.,
(In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems)
***NOTICE***.THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
0IS VALID FOR A PERIOD OF FIVE YEARS.
E a1]RON - t� HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPES # BEDROOMS# BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE i4 1 # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes onc)
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 220—NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE t. GqI� PUMP TANK GAL. TRENCH WIDTH r _ROCK DEPTHC LINEAR FT. �0
OTHER if ID a4r
a j
REQUIRED SITE MODIFICATIONS/CONDITIONS: O i M i1
IMPROVEMENT PERMIT LAYOUT
DCHD oyoz (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
T
PHONE NUMBER
BDIVISION NAME
/' v L) C-- S U i l A --J C—. . 2.-2 v 8' LOT #
DIRECTIONS TO SITE ( 4 o I tJ 4�� t'
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER n! S-/1 e► �w�—�
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 1 am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
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AUTHORIZATION NO j�`�,� ��DAVIE COUNTY HEALTH DEPARTMENT - � Q�'-
'.��-�-�--- ri,�;�-�"' � x� ` Environmen t a l Hea l t h. Sec tion .' P R O P E R T Y I N F O R M A T I O N
.PeTmittee 1,.,%,c� � ,/ �� �,-��',?�, P.O.'Boz 848
Name;.'-'_�'���i /�'fc�i `.a� ' /'Zf?cli��,v:��c ' �Mocksville, NC,27028 `. Subdrvision Name:
� ♦ �. . . ..� .. i . • F,i .� .. ., . . �, . ., . , . . .�' . :.... ..
° '� ' /� Phone # 336-751-8760
r
� Directions to property: r'��`; �'"'�,� � �,� � �/ /�/ . Section: � Lot:'
AUTHORIZATION FOR
� .�,. `^'. �� . � I � ;WASTEWATER ' ' �
r. �,f/ � � ,�-, f� � Taz Office PIN:#�,� , S� /r -' .� 3._.S
�� : . SYSTEM CONSTRUCTION 1•-
� � ; �'3 µ�y
Road Name: /� � � � �Zip:,
. , ; ;: .
**NOTE** This Authonzation'for Wastewater�Sy'stem Construction MUST BE ISS(JED by.tHe Davie County Environmental Health Section prioi
: to issuance of any BuildingPermits: This Porm/Authorization Number should be presented to the Davie County Building Inspections
� Office when applying for Building Permits. , , �' ` � ' • ' �
(ln compliance with Art�cle 11',of G.S. Chapter,130A, Wastewater Systems Section 1900 Sewage Treatment and Disposal Systems) ,
`.'�� r � ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
' ' ~ ' � ' + "� -' �� , Ci / , ' �I5 VALID FOR A PERIOD OE FIVE YEARS.'
�� � � . . -
ENVIR `NMENTAL H ALTH SPECIA,LIST •' 'DATE ISSUED � ,
' � . . . _. _� . , _ . �7 . . - . . . , . .
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DAME COUNTY HEALTH DEPARTMENT Qd"
) a' JNTpROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Subdivision Name:
Dlreti'ons t property: a 'rpt' / r`f' Section: Lot:
'� '` r: IMPROVEMENT
s F' PERMIT Tax Office PIN:#,
+t 14
Road Name 16.0 t N f - .
Zip:
**NOTE** Tbis Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An .
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
' . constructionfinstallation of a system or the issuance of a building permit.
(In co v ance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
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 TYPEy(7!c" # PEOPLE # PEOPLF/SHIFT # SEATS INDUSTRIAL WASTE. Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) –y-� �n NEW SITE REPAIR SITE•_
SYSTEM SPECIFICATIONS: TANK SIZE,—/,'-' PUMP TANK GAL. TRENCH WIDTH,.) Lel ROCK DEPTH LINEAR FT,
OTHER,
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPEC STEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # EPd .
OPERATION PERMIT
STEM INSTALLED BY:
V .
i
_i
i
AUTHORIZATION NO / 9' 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 05/96 (Revised)
i
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERNUT & AIC
Davie County Health Department
EnvirollmentaiHeaith Section
P.O. Box 848/210 Hospital Street /
Mocksville, NC 27028
n (336) 751-8760
/ . he. 0.-1 i I
s. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Yes F"o
'"IMPORTANT"* CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 2-f,00 WRITE DIRECTIONS (from Mocicsville) to PROPERTY:
Tax.Office PIN: # d J74, D / /Jo r --' -t /-) 716
Property Address: Road Name 2Z,()-5 f , S '� - /«✓'�
City/Zip !a'L' �', �Y - , �'
a GStli �"•
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot: Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No.
Revised DCHD (07/99) Invoice No. 1py
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THErREQUIRED
I
INFORMATION IS 'PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1.
%
Name to be BilledAP
Contact Person
it>/�'r/1
Mailing Address cJa
Home Phone %-57- 6 t12-
ZCity/State/ZIP
City/State/ZIP,vr
7Q Business Phone
2.
Name on Permit/ATCif Different thane Above
Mailing Address 6 .b_ a' 3?j O ` 'City/State/Zip
/
,f /U. (. 2%0
i
3.
Application For: ❑ Site Evaluation
EkImprovement Permit/ATC [l Both
4.
System to service: ❑ House ❑ Mobile Home
U.—Business ❑ Industry ❑ Other
5.
If Residence: # People #
Bedrooms # Bathrooms
❑ Dishwasher LI Garbage Disposal U Washing Machine LI Basement/Plumbing 1.1 Basement/No Plumbing
6.
If Business/Industry/Other: Specify type
i" # People ✓Q # Sinks Z-
# Commodes �_ # Showers
#
#.Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) .� Q
7.
Type of water supply: G-County/City
❑ Well U Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Yes F"o
'"IMPORTANT"* CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 2-f,00 WRITE DIRECTIONS (from Mocicsville) to PROPERTY:
Tax.Office PIN: # d J74, D / /Jo r --' -t /-) 716
Property Address: Road Name 2Z,()-5 f , S '� - /«✓'�
City/Zip !a'L' �', �Y - , �'
a GStli �"•
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot: Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No.
Revised DCHD (07/99) Invoice No. 1py
Parcel #: G300000031
Davie County, NC - Basic Estate Search
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Vie v Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: G300000031
Account #:82523583
Owner Information
133,50
Tax Codes
Improved
ORRIS ROBERT WILLIAM& MORRIS ANGELA JAMES
83,42(
ADVLTAX - COUNTY T
216,92(
10 BOB WHITE RUN
216,92(
FIREADVLTAX - FIRE TAX
0
ALISBURY NC 28147
0410
Property Information
2002 WD
Township
Improved
nd (Units/Type): 0.766 AC
3 00428
MOCKSVILLE
07
[Address: 2203 N US HWY 601
Unqualified
Deed Information
10,000
Local Zoning
0097
Pate: 04/2016 Book: 01017 Page: 0097
2016 TD
Unqualified
Improved
lat Book: Page:
i 00581
Legal Description
11
PIN
Qualified
10.766 AC HWY 601
175,000_
5820516557
Property Values
Page
uildin :
133,50
BXF:
Improved
Land:
83,42(
Market:
216,92(
ssessed:
216,92(
Deferred:
0
Sales Information
No. Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
L 00193
0781
04
1997 WD
Unqualified
Improved
0
>_ 00405
0410
01
2002 WD
Unqualified
Improved
0
3 00428
0643
07
2002 WD
Unqualified
Improved
10,000
1 01017
0097
04
2016 TD
Unqualified
Improved
149,000
i 00581
0272
11
2004 WD
Qualified
Improved
175,000_
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=1479604 8/23/2016