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3464 Hwy 601S (2)Permittee''r,/j j DAVIE COUNTY HEALTH DEPARTMENT Name:! Environmental Health Section PROPERTY INFORMATION t f P.O. Box 848 Directions to property: ' '�f' ` ` a`"✓ Mocksvil16, NC 27028 Subdivisio"ame: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR ✓( ff'- �;�J. WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION (a /� �/ / AUTHORIZATION NO: 002628 A — Rad NarrYe' s /jw/ (to` s'Zip: **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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ,, ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ji,='N %` °u {/ Y"" 4( t 'n • til' % '�%t IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # #BEDROOMS= # BATHS, #OCCUPANTS �,.� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT A� # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY (46, DESIGN WASTEWATER FLOW (GPD) a;o NEW SITE REPAIR SITE fN�" �rrri SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ` ROCKDEPTH�LINEAR FI:.�,, REQUIRED SITE MODIFICATIONS/CONDITIONS: Vt' -�/.s 6 X3 x-& IMPROVEMENT PERMIT LAYOUT.3/Z glt7� / �/s0 / y 3. A ;2fU`Sj 7 :5�.1 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT 0 -41jl ,,((►► ^ n�� �/�r �+ TEM INSTALL'• y✓ �J � " / b �. � C,�1 � C�Mbefs 64a�le /- /t, AUTHORIZATION N_�pOPERATION PERMIT BY: "*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVEAS BEEN,IN&'PALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEM '` BLiC SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME; � Dail) oaoiceevisea, qWr�- 5917NO40e 5,5Vq `� Permitt t .'. 1 f' DAVIE COUNT:HEALTH DEPARTMENT N�mer` Environmental Health Section PROPERTY INFORMATION .. P.O. Box 848 , Directian�sltoprP v' '? Jx ' Mocksville, NC 27628 Subdivision Name: ' f ---o - Phone #: 336-751-8760 x; r Section:. el -:0t: AUTHORIZATION FOR WASTEWATER - SYSTEM CONSTRUCTION Tax Office PIN:# AUTHORIZATION NO: 002628 A— R �d Nank "W � & OIS'Zip: **NOTE** This Authorization for Wastewater System Construction MUST I3EISSUED by the Davie County Environmental Health Section prior JL 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. ,z (In compliance with Article '.1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ! > ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ' IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE IV # BEDROOMS #BATHS #OCCUPANTS_ GARBAGE DISPOSAL: Yes "or No w COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFI' # SEATS INDUSTRIAL WASTE: Ye§ or No LOT SIZE TYPE WATER SUPPLY r DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK N GAL': TRENCH WIDTH ROCK DEPTH ✓ LINEAR FT�/ OTHER `. . REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ?b jC y �/ j� y X y �.0 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT C��l�fb�r 5 �al 2 Gnat/� 7a �G� r` 20 i AUTHORIZATION NOj/ryS� OPERATION 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. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) '"Y�� PHONE NUMBER' ADDRESS (7C 11L©SL d,elz ^I-/ 1 DIRECTIONS TO S SUBDIVISION NAME LOT # DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY_ NUMBER BEDROOMS 4V 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. ftev. 1193 •- Penni• ee' % ,.>. = DAVIE COUNTY HEALTH DEPARTMENT Name: i ., Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: Mocksville, NC 27028 Subdivision Name: rf ;� r �• ; :. Phone #: 336-751-8760 Section: Lot: ..r AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION AUTHORIZATION NO: 9 A Road Name: Zip: "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 13OA,'WastewaterSystems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ./-Ile !` l IS VALID FORA PERIOD OF FIVE YEARS. }ENVIRONMENTAL HEALTH SPE IALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WAPEA'St�JPPL DESIGN WASTEWATER FLOW (GPD) �v NEW SITE REPAIR SITE r lr SYSTEM SPECIFICATIONS:. TANK SIZE '' GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. 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 (336)751-8760. 'AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL II*fDICATE 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 BE TAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02102 (Revise ' a .+�'""+ .."t .\ L .y.' ''.;,T •a-; '-Vt+•..,. •-" ! - .4,.i n.4 r.. zYi:w-d.+H+.•rtm.:z '�^ fF :`;' ~ � . -r a-' ... n .u.-* 'v .. " �..t. - 'Y •rte Pernu't%eu•.tro+_'."` �� S '° -,+i ,' x -' DAVIE COUNTY HEALTH DEPARTMENT Nato f r •Jif 'A > ;Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to'property t t' ..+ ] k�" • •'`E' r s` 'Mocksville, NC 27028 Subdivision Name: } Phone #: 336-751-8760 Section: • Lot ; fAUTHORIZATION, FOR WASTEWATER Tax Office PIN:# - SYSTEM CONSTRUCTION - AUTHORIZATION NO: 9.9 A Road Name: **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 Forrri/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of GS. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,,_, IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE #BEDROOMS' #BATHS S # 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 ROCK DEPTH 1' , LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: bCHD 02/02 (Revised) b y` a AUT IDRIZATIOMN' • . O:'. 6$8 .>. 'DAME COUNTY HEALTH'DEPARTIVIENT F =. Environmental Health Section PROPERTY INFORMATION Permittee, P.O.Box 848, Name , 17 P /,t .Subdivision Name ��� Mocksvi11e,NV 27028 Phone#:7047634-8760. Directions to property:: f Section Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# 'SYSTEM CONSTRUCTION tt p Road Name **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits..This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. ' (Incompliance with Article 11 of G.S.Chapter 30A,Was tewaier Sysiems,'Section,1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ' ENVIRONMENTAL HEALTH SPECIALIST DAT$ISSUEb t ENVIRO , j�.,. � .1 r.a��,y a'° "'S' r 'r -s« -p.�„y y,+:.-v-+�ifc'�y..�,� '•A+t.i` f '•i ? '?a`%.� ! "ia r� .. ,. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION .;_ �,/ .� v'9Cc��7Jiti/!t' Subdivision Name: �irections to property: Section: Lot: IMPROVEMENT PERMIT. Tax Office PIN:# - Road Name:_Zip:1 6 sus i p rr' ***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: BUILDING TYPE J # BEDROOMS 'I— # BATHS # OCCUPANTS /O GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE - # PEOPLE # PEOPLE/SHIFf - # SEATS INDUSTRIAL WASTE:. Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE L TJ - SYSTEM SPECIFICATIONS -.'TANK SIZE GAL. PUMP TANK GAL.,.: TRENCH WIDTH ROCK DEPTH /21' LINEAR FT. OTHER 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) 6348760. OPERATION PERMIT SYSTEM INSTALLED BY: _/�/l/Lfn [ip2ffYL` 'r DCHD 05/96 (Revised) - - x a° z DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pervnlftee s Subdivision Name: Directions to property: f'''¢ Section: Lot:`` IMPROVEMENT PERMIT Tax Office PIN:# Road Name: Zip: ,—� /C`,; *NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/mstallation 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: BUILDING TYPE _� # BEDROOMS r # BATHS �--' # OCCUPANTS 14 GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE I # PEOPLE( # PEOPLEISHIFr # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) lr?4 NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS:'TANK SIZE GAL. PUMP TANK GAL,., TRENCH WIDTH r: ROCK DEPTH LINEAR FT: i OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "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: % .' AUTHORIZATION NO. _Oki)Z1 OPERATION PERMIT BY:4/ DATE: f "THE ISSUANCE OF THIS OPERATION PERMIT,$HALL RYDICATE 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) r , • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION iA) /gg`S APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER ADDRESSc�rlf�z'��! SUBDIVISION NAME LOT # IDIRECTIONS TO SITE DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER /Bo Eh FACILITY /4, UMBER 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 f9ev. 1 193 I i Parcel #: N600000016 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search . Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: N600000016 Account #: 60649240 Owner Information ulldin : Tax Codes BXF: RHA\NORTH CAROLINA MR INC nd• ADVLTAX - COUNTY T arket: 175 WEST NEW HAMPSHIRE AVENUE ssessed: FIREADVLTAX - FIRE TAX Deferred, OUTHERN PINES NC 28387 289,500 3 01004 0623 11 Information Unqualified Township EressProperty (Units/Type): 0.940 AC 4 00135 0859 02 JERUSALEM :3464 S US HWY 601 Vacant 7,000 Deed Information Local Zoning Pate: 11/2015 Book: 01004 Page: 0618 Plat Book: 0004 Page: 060 Le al Description _PIN LOTS 1-4 BOXWOOD ACRES 5755114784 Propertv Values ulldin : 120,17 CI BXF: 1 00151 0598 11 nd• 1742 arket: 13759 ssessed: 13759 Deferred, Improved Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00151 0598 11 1989 WD Unqualified Improved 1,404,000 2 01004 0618 11 2015 WD Unqualified Improved 289,500 3 01004 0623 11 2015 NW Unqualified Improved 0 4 00135 0859 02 1987 WD Qualified Vacant 7,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 Out, I 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.daviecountyne.gov/itsnetfView.aspx?prid=1426341 7/29/2016