2125 Hwy 601Sy i a Yi ` 9 �. ja;}-y •;�-i.r 4 .;�tw viy .�.,c .c ,f.v r-.v.. a-wr'.f� y r:-'., R''-ai�4`YT. ,..iii w.. ..;'y_ ...
•AUTHORIZATION NO 1 2 6 8 DAVIE.COUNTY,HEALTH DEPARTMENT
y Environmental Health Section PROPERTY INFORMATION
Permittee'^ --" P.O. Box 848
Name. 1_ Mocksville,NC 27028 Subdivision Name:
P
net 704-634-8760
Directions to "property: hI .1 Section: Lot:
AUTHORIZATION FOR
Z1 Z Sr % (y: L T �i4 3 ' WASTEWATER Tax Office PIN:#
�+ SYSTEM CONSTRUCTTON - -
Qr1�T��1eb"tf? Road Name: Zip
Zip; 1%2
**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 , ith cle 11 f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
1
' - ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS. ,
ENVI O E fAL ALTH SPWkLIST DA IS UED .
„,.,. X -x. `..w� �,rp ` i � � -`"':i'”'",�r'lr,.�'e``yw'Y•_yVn...P:•r ar-'lrr.n'r'�,I,i �,..,���prVr gK<... Y,' [MJY s,;..�;l+. �w'j" `!'t ,
268 DAVIE COUNTY HEALTH DEPARTMENT'
c -p0 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee' "~°
rr"NSubdivision Name:
Directions to property: Section: Lot:
' . IMPROVEMENT
[, 'C i 0,4 S PERMIT Tax Office PIN:#
RoadName: Zip•t
**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.
(In compliance wide 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
_ • ,:..�L_ . --- --' i PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRO AL IIBALTH SPECIALIST DA IS UED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
i INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS Z # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL
{SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZEy✓ ^ TYPE WATER SUPPLY 0DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE '
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTHROCK DEPTH 1Y LINEAR Fr. 2Ck:=>
OTHER i7f -:5 T4'16y i7,.i tjcs]C
REQUIRED SITE MODIFICATIONS/CONDITIONS: 145M -L-1- d/J rani -0012
IMPROVEMENT PERMIT LAYOUT
�+ 41`6
IL
**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 PERMrr
SYSTEM INSTALLED BY:
AUTHORIZATION NO. 1-2 YOPERATION PERMIT BY: DATE:
**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.
DC11D 05/96 (Revised)
7 13r..e -s.y... r -:.p :vm Fr e.r':rsl i ✓ayr"�`°°"^r< /'^ r '1t "vd rJ"' 4S.- .. , v - .ate ...:
268DAVIE COUNTY HEALTH -DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Perm
.. Na,111e.'' `�`= -.-• - Subdivision Name:
s Directions to property: f 11 � fr Section: Lot: t
IMPROVEMENT
Z ! ? ,. z;wV LCA 7 fA + PERMIT Tax Office PIN:#
RoadName: f Zip:
**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 pemut.
(In compliancewith 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 -
ENV k0 EPITAL HEALTH SPECIALIST DA NE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE' # BEDROOMS ---> # BATHS Z # OCCUPANTS J GARBAGE DISPOSAL: Yes or No
3 _
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHwr I # SEATS INDUSTRIAL WASTE: Yes or No
A
LOT SIZE 'y✓j(� A TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL.. TRENCH WIDTHROCK DEPTH /Y ' LINEAR FT.
OTHER
�1
'1
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: 1
1=
AUTHORIZATION NO. f—'L _PERATION PERMIT BY: '/� DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAPS BBEEI RINSTALLED IN COMPLIANCE '
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS'VBUT SH L IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIyEN PERIOD OF TIMET
DCHD 05/96 (Revised)
kd9A p �' ••rte
W��DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
.ter Q
M Lea az. e- r PHONE NUMBER
ADDRESS In O - SUBDIVISION NAME
/ V LOT #
DIRECTIONS TO SITE l0 Gd a5-74- GI ids Y1 e '� O
D-iFL' l��s cl e >j e's
DATE SYSTEM NSTALLEd? NAME SYSTEM INSTALLED UNDER 2
�5q"
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY-0A99—SPECIFY PROBLEM OCCURRING V� g-u%sl�
DATE REQUESTED 3A " / INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I unde stand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
o�J
Parcel #: L5070A0022
Davie County, NC - Basic Estate Search
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Parcel #:L5070A0022 Account #:57180000
Owner Information
Buildin :
Tax Codes
BXF•
LOT r SHERMAN E& PLOTT DOROTHY G
nd:
ADVLTAX - COUNTY T
Market:
131 US HIGHWAY 601 SOUTH
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
00158 0204
03
Property Information
Qualified
Township
nd (Units/Type): 1.000 LT
3
JERUSALEM
ddress: 2125 S US HWY 601
1996 WD
Qualified
Deed Information
45,500
Local Zoning
ate: 06/2007 Book: 00718 Page: 0613
05
2002 WD
Plat Book: Page:
Improved
73,000
Legal Description
PIN
10.655 AC US HWY 601
5746154827
Property Values
Buildin :
60,82
BXF•
Price
nd:
22,00
Market:
82 82
ssessed:
82,82
Deferred:
2
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved
Price
1
00718 0613
06
2007 TD
Unqualified
Improved
55,500
2
00158 0204
03
1991 WD
Qualified
Improved
44,000
3
00186 0712
04
1996 WD
Qualified
Improved
45,500
4
00422 0206
05
2002 WD
Qualified
Improved
73,000
View Property Record for this Parcel View Map for this Parcel View Tax Bitl Information
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vAeVie�c�`
000rivi--111:
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=1463452 8/3/2016