2174 Hwy 601S-.• r DAVIE COUNTY HEALTH DEPARTMENT
r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
,�
-Name �.,..r rr/;�:a��!%,�r�.�d �, -'f f,,�Xs� _�h Date —,Ll - y� N2
5791.
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ��+ Mobile Home — Business Speculation
No. Bedrooms 2 No. Baths _Z No. in Family
Garbage Disposal YES ❑ NO Q-- Specifications for System:
Auto Dish Washer YES NO ❑��
Auto Wash Machine YES NO ❑ ����(%�` f_p�
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended ,use change.
�r
Improvements permit byre`'.
*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
J
-------------------
Certificate of Completion 2 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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department Com'
Environmental Health Section' Ov 2' 1 Com'
P. O. Box 665 Ci�,vD
Mocksville, N.C. 27028 pa
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Re uested Byb e -r I e('.So K Business Phone
2. Address u � DJC 1, &, m De bu Ile, Neyya �
-3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
C) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people 7
6. a7 If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms— Bath Rooms— Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes urinals
garbage disposal
lavatory showers washing machine
dishwasher sinks'
8. a) Type water supply: Public ed"" Private community
b) Has the water supply system been approved? Yes -00—
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify. that the information is correct to the best of my knowledge.
No�e� bPc 11�, I 9 �9
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
�. hou
Ca It b21�r2- L' OM i t\�a-
*NOTEs Improvements Permits shall be valid for a period of S.
years from date issued. Improvements Permits are subject
to revocation, if site plans or.the intended use change.
Effective October 1, 1989.
DCHD (6-82)
I
Name—
Address
FACTORS
DAVIE COUNTY.HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
ARFA 1 ARFA ?
Date l/AbAr
Lot Size ��dc
ARFA 3 . ARFA A
1) Topography/ Landscape Position
8)
9)
®
PS
Z
PS
PS
55
PS
U
U
U
U
2) Soil Texture (12-36 in.) Sandy,
Clayey, (note 2:1 Clay)
SS
qLoamy, )
S
U
3) Soil Structure (12-36 in.)
Clayey Soils(fS%
S
S
S
U
U
U
1) Soil Depth (inches)
4�1U
S
Sff�
U'
i) Soil Drainage: Internal
S
----&
External
/V
__-._2p
U
U
U
i) Restrictive Horizons
Available Space
y
S
UU
U
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Site Classification
Y, 5.
1 R 5'
`
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by _
SITE DIAGRAM
YS
DCHD (6-82)
Title Date o
Parcel #: L510OA0032
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for tihis Parcel View Map for this Parcel View Tax Bill Information
Parcel #: L510OA0032 Account #:82523725
Owner Information
Building:
Tax Codes
BXF:
Hrl AKER JOYCE A
Land:
ADVLTAX -COUNTY TA
Market:
162 COUNTRY LANE
Assessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 1.710 AC
JERUSALEM
ddress: 2174 S US HWY 601
Deed Information
Local tonin
Date: 08/2004 Book: 2004E Page: 0265
Plat Book: 0002 Page: 084
Le al Description
PIN
LOTS 1-2 + 31-32 FOSTER
5746154123
Property Values
Building:
69,63CI
BXF:
2,3201
Land:
22 55
Market:
94 50
Assessed:
94 50
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 2001E 0180 06 2001 WL Unqualified Improved 0
t 2004E 0265 08 2004 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
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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
h4://maps.daviecountync.gov/itsnetfView.aspx?prid=1466009 7/14/2016