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AUTHORIZATION NO: Q 9 9 Q DAVIE COUNTY HEALTH DEPARTMENT
e� Environmental Health Section PROPERTY INFORMATION
Permittee's - / P.O. Box 848
-Name:-- 64 J zc" %/ Mocksville, NC 27028 Subdivision Name:
F -r Phone #: 704-634=8760
Directions -to propertyz-;� Section` Lot:
AUTHORIZATION FOR
' WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
RoalName:��
�- Zi 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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits. '
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATIONTOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
E TAI HEALT SPECIALIST DATE ISSUED
LNF. -..
tNrfs ''%/;�' �'' A".x �.Fk,a.=r'> Y� t4`�..:_ ., k :y i,x tl+Jri c.. v a �'r, y,r .fh, „y„' fr+tti'`sTa a�.t ♦+f Uk �',r wA�-'"t.ri 'ir, ri'cxrtr=,.:y� c -:s'::
jot
F DAVIE COUNTY HEALTH DEPARTMENT v y
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Ni ? r . J°r "i Subdivision Name:
rirec�ionso propeR/"�y I ✓`` a',� Section: Lot:
v IMPROVEMENT
PERMIT Tax Offia PIN :# -
A .i i
l gig
RaName: � D 1S . zip. �' 0A$
**NOTE** This Improvement Permit DOES NOT authorize the constriction 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 HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM. -
RESIDENTIAL SPECIFICATION:'BUII DING TYPE / ' "` # BEDROOMSy#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 4 _ ROCK DEPTH LINEAR Fr. (Z�
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"*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:
Evia ?,3�
�v .
J=
a M
AUTHORIZATION NO.y 1 1 " OPERATION PERMIT BY: DATE: r i�
"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 HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's�
Subdivision Name:
Piriiitionrtd property/ el Section: Lot:
EWPROVEMENT
PERMIT Tax Offige PIN-#
R1
adName: kols, _zip: g70013
**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
constructionlinstallation 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 HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTL4kLSPECIECAIlON-UILDING ME #BEDROOMS'
# BATHS # OCCUPANTS':. . GARBAGE DISPOSAL: Yes or No
V
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS -L— INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE—, REPAIR SITE,
S�FEM SPECIFICATIONS: TANK SIZE 'GAL. PUMP TANK
—GAL. TRENCH WIDTH, ROCK DEPTH42?-,'LINEAR Fr.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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.
ATION PERMIT
SYSTEM INSTALLED BY:
x,
ever) A
V,
m.N<3
AUTHORIZATION NO.0 OPERATION PERMIT BY: �r T 1 �IZ. nATF.-
!"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 SATISFACTORIL?FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
ORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER
ADDRESS S SUBDIVISION
DIRECTIONS TO SITE
NAME
SUBDIVISION LOT
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED %</��� INFORMATION TAKEN BY
Parcel #: L5010B0013
Davie County, NC - Basic Estate Search
t
Basic Search Real Estate Search Tax Bili Search Sales Search 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: L5010B0013 Account #: 82525930
Owner Information
Tax Codes
ADVLTAX - COUNTY TAA
READVLTAX - FIRE TAX
RESNELL RAY
1886 US HIGHWAY 601 SOUTH
OCKSVILLE NC 27028
BXF:
3,7101
PropertV InformationTownshi
53,52
nd (Units/Type): 1.760 AC
ddress: 1885 S US HWY 601
JERUSALEM
Assessed:
173.29
Deferred:
Deed InformationLocal
:9
tonin
Pate: 11/2005 Book: 2006E Page: 0080
Plat Book: 0001 Page: 005
Le al Description
�— PIN
LOTS 20-22 + 90-92 + 2 FTDANIELS PARK
5746085990
Property Values
Buildin :
116,0601
BXF:
3,7101
Land:
53,52
Market:
173 29
Assessed:
173.29
Deferred:
Sales Information
No. Book Paye Month Year Instrument Qual/UnQual Improved Price
L 00125 0668 01 1985 WD Unqualified Improved 0
>_ 2006E 0080 it 2005 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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001;
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/itsnetfView.aspx?prid=956049 7/29/2016