2369 Hwy 601NPermittee's DAVIE COUNTY HEALTH DEPARTMENT
Name: Zf 04 Environmental Health Section PROPERTY INFORMATION
/n� 1l,, P.O. Box 848
Directions to property: G 6 i a -T 7e Mocksville NC 27028 Subdivision Name:
Phone #: 336-751-8760
_��_�� /� � /�✓! L Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION / A "
AUTHORIZATION NO: 002902 A RPNtAle'off 4klA Zip: --'9'70
y
**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 Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
- ***NICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
AL HEALTH SPECIALIST DATE ISSUED
AVIE COUNTY HEALTH DEPARTMENT.
Name:Ir�d1,�' 6�'/1'(i'` S'� Environmental Health Section PROPERTY INFORMATION
<<t / P.O. Box 848
Dir�rtios-to,pioperty: Gr� �! h1ocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
�� 1 �`✓Y'I Section: Lot:
1• AUTHORIZATION FOR
lE WASTEWATER
J SYSTEM CONSTRUCTION Tax Office PIN:# - -
4 R. 002902 A R' �.� r°/�/
AUTHORIZATION NO: Roadad Nam zip�2-
e:
**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 Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ,
R 49
*** OTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENV{RONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE l r- # 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 �f DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE ' k'!S GfAL. PUMP TANK NAAL. TRENCH WIDTH ROCK DEPTH, LINEAR FT.
OTHER – D �J !X
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL Bim- ,LN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
of
L
SYSTEM INSTALLED BY: t5 �� I 1. _ �' ZA Y' /—
1
AUTHORIZATION NO. OPERATION PERMIT BY: 1 `1/ 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.
D0002/02(Revised) qX1 295 -AW, fnXb
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Perp�ittee•'S - , DAVIE COUNTY HEALTH DEPARTMENT
.. Name: St r'lee °f' �' r .: 5 ' C Environmental Health Section PROPERTY INFORMATION
P.O. Box848
"fes I7irectio-iji to property: '' � � " l�G' Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
t AUTHORIZATION FOR
WASTEWATER
r Tax Office PIN:# - -
SYSTEM CONSTRUCTION I'
1. s' AUTHORIZATION NO: 002902 A Roa 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 Form/Authorization 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)
OTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�v-`.;�,.� % _li✓, IS VALID FOR A PERIOD OF FIVE YEARS. r
' ENVIkONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 7"_
# BEDROOMS a^ # BATHS
# OCCUPANTS �
GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: -FACILITY TYPE
# PEOPLE / # PEOPLE/SHIFT
# SEATS
INDUSTRIAL WASTE: Yes or No
`
i
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER (GPD)
NEW SITE
REPAIR SITE
�OW
SYSTEM SPECIFICATIONS: TANK SIZE j yi' Gj7L PUMP TANK TRENCH WIDTH CCK DEPTHS LINEAR FT. 0< I
h
nTNAR
�&f/j`GAL.
t ,1,
k,
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
s
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PJ v
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL B 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. '
O RATION PERMIT t
SYSTEM INSTALLED BY: �-n'� (_ � //e ��� /I
Z11�I O�� r
Z.7
F.
07
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AUTHORIZATION NO. OPERATION PERMIT BY: / DATE:
f•
"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.
v
DCHD 07!02 (Revised) '..�, �`IW� v(/ ✓ - �� %`+"" 676b
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4,VN,.VIle DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
` APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) q
NAME p/V/�/ lyV jSf/'s) PHONE NUMBER
ADDRESS %'M us //WY &6z /V 0!'k Vil—ASUBDIVISION NAME
LOT #
DIRECTIONS TO SITE k t)/ A Home e 0 4) (LJ lbnO 7641le
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER �� !/�f'If�ll� "AMV&/
TYPE FACILITY ) NUMBER BEDROOMS 0� NUMBER PEOPLE SERVED a
TYPE WATER SUPPLY UL t' SPECIFY PROBLEM OCCURRING B%� / V✓A�2 O-(
d0ilva
i��2 Od IlelAY / Nhi4V1? n/ahl,�.m< W%�� ee r�a�si'r rv►r��.�^�ir�s �.
DATE REQUESTED'1�I�g 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
Hev. 1193
11
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Parcel #: G300000040
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Parcel #: G300000040
Account #:80432000
Owner Information Tax Codes
I
SI ANNIE BELLE D �FIREADVLTAX
DVLTAX - COUNTY T
US HIGHWAY 601 NORTH - FIRE TAX
KSVILLE NC 27028
Property Information
Township
nd (Units/Type): 0.820 AC
CLARKSVILLE
ddress: 2369 N US HWY 601
nd:
Deed Information
Local Zoning
ate: 01/1900 Book: Page:
sseS.
Plat Book: 0003 Page: 037
[Deferred:
Le al Description
PIN
LOTS 45-52 HWY 601 MABEL LLOYD
5820535502
Property Values
uildin :
63,94
CCCC
BXF•
93
nd:
17 21
arket•
82,08
sseS.
82,08
[Deferred:
Sales Information
No Sales Data found.
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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.daviecountyne.gov/itsnetfView.aspx?prid=1462692 8/24/2016