2475 Hwy 601Nk•.:. .3'...e ,..z .::.,.ii e� .... x...:: .--.. '.y'. 1 -'i4 `r \ � r '" v _
Perm'• r, s ''' r^ DAVIE COUNTY HEALTH DEPARTMENT r
N !
f Environmental Health Section PROPERTY INFORMATION
.� P.O. Box 848 - ' 21 t9 $"
'Directions to ro ert c U,�
27028 Subdivision Name:
P P, Y � Mocksville, NC
Phone #: 336-751-8760
Section: Lot:
h AUTHORIZATION FOR
WASTEWATER Tax Office PIN#
t - e^� SYSTEM CONSTRUCTION :- -
AUTHORIZATION NO: 114.! , 2 A Road Name: 4-'`�p "7
**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 FornVAuthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance w ithAn e I 1 f G.S. Chapter 130A,'Wastewater.Systems, Section .1900 Sewage Treatment and Disposal Systems)
IL
,,. ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
C,i�IROAft�!_
IS VALID FOR A PERIOD OF FIVE YEARS:
HEALTH'S ECIALIST _ DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE Npts� # BEDROOMS �" # BATHS # OCCUPANTS Z GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY T'YPPE-, # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT,SIZE TYPE WATER SUPPLYDESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP,TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. IL40
OTHER 2- 1)6W j 190 1103
REQUIRED SITE MODIFICATIONS/CONDITIONS::In1ST4LL Oro ct9,4wj'z (10 Orrolkal
**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 (336)751-8760.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME _ Ct PHONE NUMBER'j
ADDRESS 2LITS- 4v-JO1 SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED IgSS NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS Z Z I NUMBER PEOPLE SERVED Z
TYPE WATER SUPPLY Walt- SPECIFY PROBLEM OCCURRING
DATE REQUESTED Z� INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that 1 understand I amreresponsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT /�an�,�.r� '/,�,7. Aei
Rev. 1 193
Parcel #: L500000035
Davie County, NC - Basic Estate Search
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Parcel #: L500000035 Account #: 18004000
Owner Information
uildin :
Tax Codes
BXF:
ORRELL JERRY R& CORRELL LIBBY R
Land:
ADVLTAX - COUNTY TA
Market:
[259 FAIRFIELD ROAD
ssessed:
FIREADVLTAX - FIRE TAXOCKSVILLE
eferred•
NC 27028
Property Information
Township
nd (Units/Type): 1.130
Fddress:
JERUSALEM
2475 S US HWY 601
Deed Information
Local Zoning
Date: 02/1994 Book: 00172 Page: 0572
Plat Book: Page:
Legal Description
PIN
1.44 AC HWY 601
5746433195
Property Values
uildin :
10,37 CI
BXF:
Land:
8 53
Market:
1890
ssessed:
1890
eferred•
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00125 0751 02 1985 WD Unqualified Vacant 0
2 00172 0572 02 1994 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,
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=1492440 8/9/2016