2336 Hwy 601N% Q Q a L5 U L5 U Vl U4
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION ,SGT , O 2000
C) e;►�- APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME �j �_,� (,�S ���e L,n-� 1� PHONE NUMBER 7o►
L- URVILtIVU1111
ADDRESS 3 4(rJ y (p_z) SUBDIVISION NAME
C ieS 01 I� N C- LOT #
DIRECTIONS TO SITE JyN 11 S O�-s�- t� v O g .-�
e- j J /7L < L /3 a 1
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER I
TYPE FACILITY �v NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY on Co IL q SPECIFY PROBLEM OCCURRING �< •-� QCT W
U 41
DATE REQUESTED la 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 C h
Rev. 1193 )-7-7
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x r e` AU�TI-�ORIZATION I�l�. �� D�i� DAVIE COUNTY HEALTH DEPARTMENT ,.
} �.�, � �u ; Environmental Health Section � PROPERTY INFORMATION
;Perm�'ttee ti%�� ��,y'� r � • , '
� 1::�'�� �tt,.�..C.� � l � �.1,.��� ' PA:'Box 848 :
'Name: ' Mocksville, NC 27028 ' Subdivision Name:
.., . , ,
Directions fo property: �� l�K (pt�1a.� : Phone # 336 751=8760 '
' � ' Section: Lot: �
, ; :. AUTHORIZATION FOR ,
(�-- � ` WASTEWATER
�,.._ t.? 11 i� ' � W�i t.L:s �/a�,�r' �► �iU � Tax Office PIN:# ' _ _
. SYSTF,M CONSTRUCTION ����
� �N �'—� ` Road Name: VS- i I � � iJ (rC)��ip: �'�t�2 �
**NOT'E** This Authorization for Wastewaier Sysfem Construction MUST BE�ISSUED by ttie Davie Counry Envuonmental Health Section prior
to issuance of.any Buildin Permit�: This Forni/Authonzation Number should be presented to the Davie County Building Inspections `�
� ' Office when applying f uilding Permits: ` � ` : � , "
.(ln compliance wi 'Arf' "e- f.S. C,ltaptcr-�.30A, Wastewater Systems Section :1900 Sewage Treatment and Disposal Systems) `
' -' � '� � �' ' � " � ***NOTICE*** TNIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
' ^ �,' � I'� �(� �.' a IS VALID FOR A PERIOD OF FIVE YEARS.
O E L SPECIA IST�DATE ISS ED'
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6 0DAVIE COUNTY HEALTH DEPARTMENT
• . IMPROVEMENT AND OPERATION PERMITS PROPERTY, INFORMATION
l �Nak` ` E. l J �•^ `i .:.: Subdivision Name:
Directions to property: # t,)tf ` l c 1 Section: Lot:
1
t L t; t �.: -; (,} ERMIT Tax Office PIN:#
Road Name: x S� 1,, �`{ >1ip:,'
�� - ^r
**NOTE** This 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
construction/installation of a system or the issuance of a building permit ` .
(In compliance with Article I .,of O.S. Chapter -ROA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERNUT IS SUBJECT TO REVOCATION IF SITE
i i r'1 v (' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
NVIRbN&ALHEr1Is PECIXi,1-S DATE ISS D SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM. .
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS #.BATHS #OCCUPANTS y .GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPL�DESIGN WASTEWATER FLOW (GPDj NEW SITE_L_ REPAIR SITE .
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.���
OTHER c..,!
REQUIRED SITE MODIFICATIONS/CONDITIONS: k S� > u- 01) �`� VQ,
20.
to' �
lOU �t3G K/2'r70t4L "1Q'M1M, -To POOP. WVAC.
**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 @4}694 O.
xxxxx xxx
635) - 6
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AUTHORIZATION -NO. - 1-LGERA N rr BY: TE:O
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE YIiAT THE SYSTE ED ABOVE HAS STALLEDPCOMPLIANCE
WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WKEN'AS A`
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
Parcel #: G305OA0001
Davie County, NC - Basic Estate Search
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Parcel #: G30SOA0001 Account #:14017000
Owner Information
Building:
Tax Codes
BXF:
RTNER JAMES HUGH JR
E1485
Land:
ADVLTAX - COUNTY
T
Market:
POWELL ROAD
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
OODLEAF NC 27054
Property Information:9
Township
nd (Units/Type): 0.910 AC
Vddress:
MOCKSVILLE
2336 N US HWY 601
Deed Information
Local tonin
ate: 11/2009 Book: 00811 Page: 0061
lat Book: 0002 Page: 072
Legal Description
PIN
LOTS 1-8 GRAHAM
5820538288
Property Values
Building:
87,7401
BXF:
8301
Land:
17 54
Market:
106 it
ssessed:
106 11
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00191 0324 11 1997 WD Unqualified Improved 30,000
t 00811 0061 11 2009 WD Qualified Improved 83,000
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
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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=1468728 8/18/2016