2440 Hwy 601N (2).fQ- o ;
AUTHORIZATION NO: 35,
DAVIE COUNTY HEALTH DEPARTMENT .. -----M�--- - w-:
Environmental Health Section PROPERTY INFORMATION
Permittee's" ---, P.O. Box 848
Name:— 3 t� :-l+`�c_��c/ Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760
Directions to property ul-w (off l t ., Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION O q qo
Road Name: )q 1st) !'� Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Perrnits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article11 of S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A' PERIOD OF FIVE YEARS.
ENVIR�DTE SUED
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_. DAVIE COUNTY HEALTH DEPARTMENT.. ; -< •��— w - --
„{��} IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
PernutTee's ,..„r
4Namet ; Subdivision Name:
birections to property: Section: Lot:
` IMPROVEMENT
PERMIT,,Tax Office PIN:#
Road Name: l..s.) Zip:
**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 11 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 HEALTHSPEciALjST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
` INSTALLING THE SYSTEM.s
RESIDENTIAL SPECIFICATION: BUILDING TYPE iJ # BEDROOMS # BATHS
i #OCCUPANTS GARBAGE DISPOSAL: Yes r Io
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
C
LOT SIZE STYPE WATER SUPPLY )7Y DESIGN WASTEWATER FLOW (GPD) ��JJ�` j� NEW SITE REPAIR SITE I
SYSTEM SPECIFICATIONS: TANK SIZE 1 pO2GAL. PUMP TANK GAL. TRENCH WIDTH SCs' ROCK DEPTH l Z LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
II
1 z.
IMPROVEMENT PERMIT LAYOUT
(o-24 A Z{
v
g S�v to
tlo S.L ..—
"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) 634-8760.
OPERATION PERMIT `S1
SU TEMIN TALLED BY:
1�
AUTHORIZATION NO. J OPERATION PERMIT BY: �/�1I C�' 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)
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DAVIE COUNTY HEALTH DEPAkTMENT
p yy' f
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Peripi ee's,"
:Name Subdivision Name:
'
151r tions to property: -�`" �..�Y �" `� Section: Lot:
-:• IINPROVEMENT
► .,y PERMIT, Tax Office PIN:#
Road Name: !.� t }° 1,..,r .. 3 ;"^ ` Zip: 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
constructionlmstallation 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)
""^ i ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
4DTU
,+PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATERENVIRONM$NTALHEALTH; SPECIALIST ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE }
INSTALLING THE SYSTEM. -
RESIDENTIAL SPECIFICATION: BUILDING TYPE h # BEDROOMS : # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes rNo
J
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE &<%STYPE WATER SUPPLY 7Y DESIGN WASTEWATER FLOW (GPD NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE' (?�)2GAL. PUMP TANK GAL., TRENCH WIDTH ROCK DEPTH X LINEAR FTO- i-)
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:()*-T!latJ"'
IMPROVEMENT PERMIT LAYOUT+ r!
r•
....
**CONTACT A PRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM '
BETWEEN 8:3Q - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT s
SYTEM IN TALLED BY:
y r
Yavr..•nww � e
r�
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: " -7
**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)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME ULASSccc �/�-, PHONE NUMBER 4 IZ'�Zq(p
ADDRESS O Iry [401 1 SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE 00 t itJ
'3`o-)
DATE SYSTEM INSTALLED !VQy00AME SYSTEM INST LLED UNDER
TYPE FACILITY HOJS,Z-; NUMBER BEDROOMS NUMBER PEOPLE SERVED AC4fJT
TYPE WATER SUPPLY C t2t T SPECIFY PROBLEM OCCURRING &--�A)&
DATE REQUESTED D INFORMATION TAKEN BY
— 6-�a
This is to certify that the information provided is correct to the best of my knowledge, that I understand I am re nsible for all charges incurred from this application.
1
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
Parcel #: L5140A000101A
Davie County, NC - Basic Estate Search
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Parcel #: L5140A000101A
Account #:53940000
Owner Information
Tax Codes
CHOLS DONALD D& NICHOLS PRISCILLA B
E430
ADVLTAX - COUNTY T
T
US HIGHWAY 601 SOUTH
READVLTAX - FIRE TAX
CKSVILLE NC 27028
ssessed:
Property Information
Township
nd (Units/Type): 0.570 AC
JERUSALEM
ddress: 2440 S US HWY 601
Deed Information
Local Zoning
Pate: 09/1977 Book: 00102 Page: 0661
[Plat Book: Page:
Legal Description
PIN
1.58 AC HWY 601
5746328483
Property Values
Buildin
BXF:
4,71
nd•
10,70
Market:
15 41
ssessed:
15 41
Deferred:
91
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00102 0661 09 1977 WD Unqualified Vacant 0
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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,
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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/itsnetfView.aspx?prid=1475256 8/16/2016