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- -- Y DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
}ATE** 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 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
PROPERTY ADDRESS M/S lI W 02) pS : "d DATE �L
LOCATION A b of U
SUBDIVISION NAME LOT NUMBER -�7 SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE ,Id/l/ # BEDROOMS 0 BATHS pc_ # OCCUPANTS GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOFILE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW�,SITE REPAIR.SITE
SYSTEM SPECIFICATIONS: TANK SIZE DD - GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR /S
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
ae+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.
S
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) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY
f(
AUTHORIZATION NO. C) 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 13OA, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FlJNCTION SATISFACTORILY FOR.ANY,GIVEN PERIOD OF TIME.
DCHD 10/95
vp
Davie County Health Department
ENVIRONMENTAL HEALTH SECTIDN'
P.D. 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 Fors/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.***
'RUTHORI ZATION NUMBER
NAME A 0/S A, 169 7/ DATE N2 j 2 IS
el"y
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
_r
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
t+' �*' ^rit> ;+:.,�`. � f'4.+ - i j "" : ':�d�°:�.�-x;;,.et£�•.,; w::=�#7 n•. r,=y�`aw..,u b'hrJ ��C:.L ri-i,-.r � , � .. - . ., ..'ti. ...�;,, - .. _ --
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DAVIE COUNTY HEALTH DEPARTMENT � 1
IMPROVEMENT PERMIIT and OPERATION PERMIT -..I , y' • </ /7 ��
- runnniirurut•'..r�urT
' NAME V /(- - � PROPERTY ADDRESS (D 01 i Y(0!2� — �'A DATE
**NOTE** ?his improyement permit'DOES NOT authorize the construction or installation of a septic tank system or any wastewater
�. systems AN AUTHORIIATION 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.
dn.compliance with Article 11 of B.S. Chapter 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
LOCATION A ha/ 1 /
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE , # BEDROOMS r_ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY -TYPE # PEOPLE # PEOPLE/SHIFT # SEATS r_ INDUSTRIAL WASTE: Yes/No
ti
LOT SIZE TYPE WATER SUPPLY DESIGN -WASTEWATER FLOW (GPD) NEUISITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZEZLOL GAL. PUMP TANK GAL. TRENCH WIDTH 1� ROCK DEPTH ,. 7 LINEAR FT/+S
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MAST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
• ,. _.rte"' ..
i
IMPROVEMENT PERMIT BY All,
**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 SYSTEM INSTALLED BY
L :Dj
1,
1�7' q �=
AUTHORIZATION NO. C) OPERATION,PERMIT BY DATE J 1
,t
i
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE -HAS BEEN'INSTALLED IN COMIPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 13OA, 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.
•r
DCHD 10/95
-
0
"P Am,
OAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
,N NAME
DIREjTIONS TO SITEyl Ol S- &Aeic�?h 9'�
•
DATE SYSTEM INSTALLED 11Y40, NAME SYSTEM INPT'ALLED UNDER -�
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
EQ STED IN OR�MATIONN 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 #: K5160A0010
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: K5160A0010 Account #:82532348
Owner Information
LOYD JAMES M JR & VIVANO-FLOYD NORMA
5665 HIGHWAY 24-27 EAST
MIDLAND NC 28107
Property Information
Land (Units/Type): 0.960 AC
ddress: 1862 S US HWY 601
Tax Codes
ADVLTAX - COUNTY T
FIREADVLTAX - FIRE TAX
Township
JERUSALEM
Deed Information Local Zoning
Date: 03/2016 Book: 01012 Page: 1174
Plat Book: 0001 Page: 005
Legal Description PIN
LOTS 6-10 DANIELS PARK 5746097233
Property Values
uildin :
58 96
BXF:
1119
Land:
16,54
Market:
76 69
ssessed:
76 69
Deferred:
3
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved Price
1
00840 0374 10 2010 WD
Unqualified
Improved 0
Z
2004E 0008 12 2003 WL
Unqualified
Improved 0
3
01012 1174 03 2016 WD
Qualified
Improved 73,000
View Property 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/itsneWiew.aspx?prid=1458032 7/19/2016