2440 Hwy 601NwT,;.i: "a., 9ft .`v'�"` a s; :.:`� , rsN+?.i, .y++6 i-•,._•' S•.. :'r -;r . i ..':.yt"s. ..: ".`:'s �..'�.a.r Y4, .,:'ti+` S '}� ::i i �„ i-'``Y+� .. e��-:i s.. c u. .... .. s.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**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 oust be obtained iron this Departoent..prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
6011)11i
NAME %��//. 1�//•Y'/� PROPERTY ADDRESS DATE Jew /95�
LOCATION �DDf s %' /9si�x�n PP'l ori✓jvrr— ,
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE !!S' P # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Y
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE:: Yes/No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 2 D NEW SITE REPAIR SITE v
SYSTEM SPECIFICATIONS: TANK SIZEX00 GALT PUMP TANK GAL. TRENCH WIDTH IZ_ ROCK DEPTH /�F"/ LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO 'REVOCATION IF SITE PLANS OR THE INTENDED USE CHAFE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
f
IMPROVEMENT PERMIT BY
**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 (704) 63478760.
OPERATION PERMIT SYS EM INSTALLED BY _
4f
`� LJ
AUTHORIZATION NO. vV� OPERATION PERMIT BY 7liwi 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 10/95
V
O ., ,
DAVIE COUNTY HEALTH DEPARTMENT ' : "`��'
r•.�. IMPROVEMENT PERMIT and OPERATION PERMIT.
IMPROiSOT'PERMITt
J.— .`**NOTE4* This`ieprovement 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ol
D/N,
NAME f/ �1'J'l�y" PROPERTY ADDRESS DATE A 3
Lf 7' Y i
LOCATION �%/::�ls-%+� _> .� r�> . 7i✓ryPr-
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE rrf # BEDROOMS _,:P, # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yq
-COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS A INDUSTRIAL WASTE: Yes/No
LOT SIZE t TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 2 D NEW SITE REPAIR SITE
SYSTEM_ SPECIFICATIONS: TANK SIZEIMb GAL PUMP TANK GAL. TRENCH WIDTH ,?r! ,ROCK DEPTH ; LINEAR fT.1 :L
OTHER
y
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. - YOUR WASTERWATER,,SYSTEM�CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT SYS EM INSTALLED BY
A
AUTHORIZATION NO. Obg
OPERATION PERMIT BY DATE 1
**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 -138A --SECTION .1900 -"SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL h CTION SATISFACTOFILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
I
.y;
IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT SYS EM INSTALLED BY
A
AUTHORIZATION NO. Obg
OPERATION PERMIT BY DATE 1
**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 -138A --SECTION .1900 -"SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL h CTION SATISFACTOFILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
I
(..3,w J h r, '•:7y 1�.1.:�� �r..:;;h.,;j;., - r -•"'S y t z,� ✓ t - � .. ... _ ,,
i/X a
Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
P.O.' Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
B.S. Chapter 130A, Wastewater Systems)
***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.***
NAME
f Gl;'
DATE /34'jr—
{A�U�T}2RIZATION NUnMBER
NAME ON IMPROVEMENT PERMIT
(If different than above)
SITE LOCATION
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
Mr�i.7A
**WICE*** THIS AUTHORIZATION F R STEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5).YEARS.
ENVIRONMENTAL HEAT. SPECIALIST DATE
DCHD 10/.95
NAME <o�S
AVIE COUNTY ENVIRONMENTAL HEALTH SECTION
�14sse PPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
p _ , PHONE NUMBER
ADDRESS �O ��/`����,.. t SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE aDI A/-
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
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 th#1 Ynderstand I am responsibli6 foj all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
Parcel #: G300000073
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: G300000073
Account #:82525092
Property Values
Owner Information
49,4801
Tax Codes
Improved
Land:
ASSCOCK LORENE E
FLM,L(OCKSVILLE,
Market:
ADVLTAX - COUNTYT0
ssessed:
101,19
DAMES CHURCH ROAD
0
FIREADVLTAX - FIRE TAXNC
01010 0175
01
27028
Unqualified
Improved
0
Property Information
1994E 0136
Township
1994 WD
Land (Units/Type): 5.170 AC
Improved
MOCKSVILLE
3
ddress: 2443 N US HWY 601
07
2005 WL
Unqualified
Deed Information
0
Local Zoning
ate: 01/2016 Book: 01010 Page: 0175
Plat Book: Page:
Le ai Description
PIN
1 LOT HWY 601
5820545752
Property Values
Building:
49,4801
BXF:
Improved
Land:
51,71
Market:
101 19
ssessed:
101,19
[Deferred:
0
Sales Information
No.
Book Page
Month Year Instrument
Qual/UnQual
Improved
Price
1
00979 0005
02
2015 QC
Unqualified
Improved
0
Z
01010 0175
01
2016 QC
Unqualified
Improved
0
3
1994E 0136
07
1994 WD
Unqualified
Improved
0
3
2005E 0197
07
2005 WL
Unqualified
Improved
0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Page 1 of 1
oP�v„1�
ot-orims
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/itsnet/View.aspx?prid=785527 8/10/2016