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��AUTHORIZATI r�- o: ,'`� � � �� DAVIE COUNTY HEALTH'bEPARTMENT , `:
,�: Environmental Health Section PROPERTY INFORMATION
Perrriittee's - P.O. Box 848 .
„-Name: l.�C� �� , x.':� Mocksville, NC 27028 Subdivision Name:
. � � ;,/S ,�-�,�'" � �� �hone # 336=751-8760 - ,
� Directions,to propeRy:- �' !�-'f� "�/� � Section: Lot:
. . ,,,�: - AUTHORIZATION FOR . . u
���,,.;�•� �j� �/'�� WASTEWATER' ' Tax Office PIN;#
. . =--=� , . SYSTF.M CONSTRUCTION.` " ' -
�: � i. Road Name: (s 0/-S Z�p: Z ZaZ�' .
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�� **NOTE** This Auth�rization for Wastewater System Construction MUST BE ISS[J�D by the`Davie Counry: $nvironmental Health Section prior
�:x� issuance of any Building-Rermits. This Form/Authorization Number sliould be presented to the Davie County Building Inspections
, `, ��.Office when applying��for-�Building Perrnits: �, . -;�'�'� � .
_ . , , . . .
(In compli e,with Article I 1 of G.S. Chapter 130A,' Wastewater Systems, S fecfion .1900 Sewage Treatment and Disposai Systems) :=
f � �. -
, , ,:i� �1. , .> ' , :
; ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,
� � � �' ,,� �.,.'�r /,T `�I ,�_ � " :� ; '. IS YALID FOR A PERIOD OF FIVE YEARS. `- ;
ENVI ONMENTAL ALTH SPE ALIST:; DATE7SSUED ��
, . ;
• . -� � . ��, ;.,
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DAVIE COUNTY HEALTH°DEPARTMENT ;
IMPROVEMENT AND. OPERATION PERMITS PROPERTY INFORMATION '
Pertnitte�'s
2Subdivision Name:
lr r,:• w.,
Dliections to property''y. r Section: Lot:
DWROVEMENT
PERMIT Tax Office PIN:#
Road Name: %D/S P�
Zi z 702e'
,**NOTE*. ,This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the.
construction/installation of a system or the issuance of a building permit.
(Incompliance with Article I l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLAN$ OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL IIEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.' ,
RESIDENTIAL SPECIFICATION: BUILDING TYPE _� # BEDROOMS # BATHS _ # OCCUPANTS _' GARBAGE DISPOSAL Yes or No '
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOP� # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE `
SYSTEM SPECIFICATIONS:.TANK SIZE G;AL. PUMP TANK GAL.TRENCH WIDTH ROCK DEPTH LINEAR FT. - I
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
+"' ,"�^"�"�,� ..�,,,,. F"f��x`•L%.,^k.'�„°a�'!%= 'b�r+"vyt'°��g �L.`Y�'d-�'.'�i:N �.�Y �.7 elf..'-'rte-`i"'� "���y� S - ? y9 .i;7N , .-P na '�., 5'�•i�a'..�'`7 .,.qx ct,`>.�:�CS I ;r' '�%
eel
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DAVIE COUNTY HEALTI DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's,•
Name:
Subdivision Name:
. -directions to property:
•� {�
, , Section:
Lot:
'
r IMPROVEMENT
PERMIT Tax Office PIN:#
At
. e
r Koaa Name: Llp:
**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
constructionrnstallation 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)
f ***NOTICE*** THUS PERMIT IS SUBJECT TO REVOCATION IF SITE
... - PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL AEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL:. SPECIFICATION: BUILDING TYPE # BEDROOMS –,!P--# 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 DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH f u' ROCK DEPTH /C3 LINEAR FT/Y/1"' 4'
f �>
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT *APPROVED F„FFLUDIT FILTER* *RISER(S) IF b1 • E
J
**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 DgY OF INSTALLATION. TELEPHONE # IS (749k34i87161 X
OPERATION PERMIT
S STEMINSQALLEDBY:
g
J
AUTHORIZATION NO. 1�V g OPERATION PERMIT BY: �� DATE: �J v
**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)
J
AUTHORIZATION NO. 1�V g OPERATION PERMIT BY: �� DATE: �J v
**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 Q PHONE NUMBER
ADDRESS__j ��- y °) S SUBDIVISION NAME
U
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
LOT #
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 that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
Parcel #: K500000007
Davie County, NC - Basic Estate Search
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Parcel #: K500000007, Account #: 82529921
Owner Information
:
Tax Codes
rarkelt:
TEELE LILLIAN JANE
ADVLTAX - COUNTY T
1565 US HWY 601 SOUTH
FIREADVLTAX - FIRE TAX
eferred•
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 1.260 AC
MOCKSVILLE
ddress: 1565 S US HWY 601
Deed Information
Local Zoning
Pate: 01/2008 Book: 2008E Page: 0065
Plat Book: Page:
Le al Description
PIN
1.256 AC HWY 601
5747130102
Property Values
:
si,1901
rarkelt:
4d35
9ed:
9
eferred•
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 03000 0017 01 2001 DC Unqualified Improved 0
Z 2008E 0065 01 2008 WL Unqualified Improved 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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oclorja--Is
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=1465461 7/29/2016