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Permittee' J - DAVIE COUNTY HEALTH DEPARTMENT ,i
Nam .` t�� jE l� Environmental Health Section PROPERTY INFORMATION
1 !1 P.O. Box 848 0
i9
Directio� s,to property: Mocksville, NC 27028 Subdivision Name:
t,, Phone #: 336-751-8760
�.� i'i a' t �� -t �. ,l'�I (' �(� Section: Lot:
T— AUTHORIZATION FOR
WASTEWATER
Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: 003005 A Rod Name A4/ I/ zip:.-, z -, )d
**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 1 I of G.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.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDINGTYPE SC # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE Cl:, # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ,% G TYPE WATER SUPPLY (0. DESIGN WASTEWATER FLOW (GPD) ,m NEW SITE \ REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE( -�,LL. PUMP TANK /GAL. TRENCH WIDTH �J. � ROCK DEPTH _Z LINEAR FT.
OTHER b '� CC Aevi n
b
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: 11�hrkAw� 1J
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AUTHORIZATION NO. 90 1091f OPERATION PERMIT BY: DATE: l Z^ `_ L0
**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 02102 (Revised) r71-75
**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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
I t .. , ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOi? , FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �X
RESIDENTIAL SPECIFICATION: BUILDING TYPE F I �' # BEllROOMS #BATHS # OCC VTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE t # PEOPLE # PEOPLE/SHIFT - # SEATS INDUSTRIAL WASTE: -Yes or No
LOT SIZEje)l G TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE � REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE f 4 " �AL. PUMP TANK _ GAL. TRENCH WIDTH`76 1 ROCK DEPTH LINEAR FT.'
n('j 7
OTHER / i `�lI !C l� �l (/�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
(+t
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. -
OPERATION PERMIT
yr1
s
04
SYSTEM INSTALLED BY:
t
22
AUTHORIZATION NO. dO 3909& OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAeSYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
u DCHD 07/02 (Revised) .. -9, ? !1 1 Id 7175 `%
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Perna e's `' w.DAVIE COUNTY HEALTH DEPARTMENT
err
Name �'r rr,
Environmental Health Section
PROPERTY INFORMATION
{
P.O. Box 848
Directionsa to L `
Mocksville, NC 27028
Subdivision Name:
Phone #: 336-751-8760
+ , +
Section: Lot:
'
AUTHORIZATION FOR
WASTEWATER
Tax Office PIN:#
-,g -
!t[;
SYSTEM CONSTRUCTION
003005
A
+
6v
' t
AUTHORIZATION NO:
�.,
Road Name: /V 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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
I t .. , ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOi? , FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �X
RESIDENTIAL SPECIFICATION: BUILDING TYPE F I �' # BEllROOMS #BATHS # OCC VTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE t # PEOPLE # PEOPLE/SHIFT - # SEATS INDUSTRIAL WASTE: -Yes or No
LOT SIZEje)l G TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE � REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE f 4 " �AL. PUMP TANK _ GAL. TRENCH WIDTH`76 1 ROCK DEPTH LINEAR FT.'
n('j 7
OTHER / i `�lI !C l� �l (/�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
(+t
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. -
OPERATION PERMIT
yr1
s
04
SYSTEM INSTALLED BY:
t
22
AUTHORIZATION NO. dO 3909& OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAeSYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
u DCHD 07/02 (Revised) .. -9, ? !1 1 Id 7175 `%
" DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
r APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
RobbivNAME ""�aS PHONE NUMBER ��g " 75
ADDRESS 32,E () o Y (0-/ N SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
miff /6/53
Er /7,090
DATE SYSTEM INS4.1-DNAME SYSTEM INSTALLED UNDER �&bb!j S0�5
TYPE FACILITY ��NUMBER BEDROOMS O NUMBER PEOPLE SERVED 02
TYP WATER SUPPLY C V (A=V SPECIFY PROBLEM OCCURRI
DATE REQUESTED '�� INFORMATION TAKEN BY=�
ca
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
Rev. 1/93
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT'AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sew �;retme and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date _�� �- N 2 4073
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms No. Baths __ No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto -Dish Washer YES ❑ NO ❑
AutoWash Machine YES ❑ NO ❑
Type Water Supply _—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements 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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
�oIAP�PJ
Certificate of CompletionDate J
*The signing of this certificate shall indicate that the system des abed above as been installed in compliance with
the standards set forth in the above regulation; but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sew re
me and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number'
�� _�' N° 4073
Name
Date
Location. dt52�eX
_ CL.c - co
324
Subdivision Name
" ""' Lot No. _ Sec. or Block No.
y
Lot Size
House Mobile Home _ Business Speculation
No. Bedrooms
No. Baths No. in Family
Garbage Disposal
YES p NO ❑
-"Specifications for System:
Auto Dish Washer
YES ❑ NO ❑
<�S%z'J�L��� ���
Auto Wash Machine
YES ❑ - NO ❑
,
Type Water Supply
_—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.-
Improvements 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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed byz,?
_ Certificate of Completion Date J
The signing of this certificate shall indicate that the system des ibed above as been installed `in compliance with
the standards set forth in the above regulation; but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. -
I
DAVIE COUNTY HEALTH DEPARTMENT
=�
IMPROVEMENTS,, PERMIT AND CERTIFICATE OF COMPLETION
"NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage/Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) , Permit Number
Name a` ` i :✓rte Date �S 4973
Location '�1ft%'�,%✓ % ;%1%� '` ��� �l/i %: ,,— `_._
IV
Subdivision Name - f '� �` Lot No. Sec. or Block No.
Lot Size Housar f Mobile Home _ Business Speculation"-�-�i
No. Bedrooms No. Baths No. in Farr ly _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ I�/�'�.,�-1�
Auto Wash Machine YES ❑ NO ❑ '
Type Water Supply_—
"This permit Void if sewage system described below is not installed within 36 months from date of issue. ti
Improvements permit by
4
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: _
System Installed by
Certificate of Completion / i� - Date
"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
-IMPROVEMENTS .PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit
Number
Name /: Date'/, / a°x
4 97 3
��'
i
. r f
r
'l
Location e �" 61-
_
j LA IV
/ ! (
Subdivision Name ""J, '# Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑
Specifications for System:._
Auto Dish Washer YES ❑ NO ❑
��' rr,j
l� /�
Auto Wash Machine YES ❑ NO ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f
Improvements 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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
.............
Certificate of Completion �!� %%� �f Date
*The signing of this certificate shall indicate that the system des dbed above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
Parcel #: E300000103
Davie County, NC - Basic Estate Search
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Parcel #:E300000103
Account #:40732000
Owner Information
Building-
Tax Codes
BXF•
NES BOBBY RAY& ]ONES PANSY M
[218
Land:
ADVLTAX - COUNTY TA
Market:
US HIGHWAY 601 NORTH
ssessed:
FIREADVLTAX -FIRE TAXCKSVILLE
Deferred:
NC 27028
Property Information
Township
Land (Units/Type): 9.954
CLARKSVILLE
[Address: 3218 N US HWY 601
Deed Information
Local Zoning
Date: 01/1900 Book: Page:
Plat Book: Page:
Le al Description
PIN -i
19.954 AC HWY 601
5821039034
ProperPropertv Values
Building-
65,40
BXF•
633
Land:
8983
Market:
16156
ssessed:
161 56
Deferred:
Sales Information
No Sales Data found.
View Prooerty 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
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=1460147 8/17/2016