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Permittee's DAVIE COUNTY. HEALTH DEPARTMENT
Name A9 Environmental Health Section PROPERTY INFORMATION
!' P.O. Box 848,
birections to property: f� ,,�?� r Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
��'�% �!'.;�r1�'�/ •lYPf rw: Section: Lot:
AUTHORIZATION. FOR
ea_ ;,k WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
AUTHORIZATION NO:. 2110 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
j li. IS VALID FOR A PERIOD OF FIVE YEARS.
.:ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
"RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOM$# BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yesor No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) %ZV NEW SITE . REPAIR SITE 4'
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 'a LINEAR FT..
OTHER1/i4*�OJ�
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.
DCHD 0I102 (Revised)
V1,
O.
DAVIE COUNTY HEA
LTH DEPARTMENT
Environmental Health Section
PROPERTY INFORMATION
P.O. Box 848.
$`Ct►a►�sd'-aro!Pen3� `1 '�-f r Mocksville,,NC 27028 Subdivision Name: 1,
r .;. Phone #: 336-751-8760
r w- �„ ak, t. - . Section: Lot:
-41"71
AUTHORIZATION FOR
WASTEWATER
t>` F ''� s° J .t f r.� Tax Office PIN:# - -
SYSTEM CONSTRUCTION
.AUTHORIZATION NO: '2 TO A Road Name: - a`
Zip:
**DOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
Ito issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building !pspections
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment andT3isposal Systems)
r , _; •.
***NOTICE*** THIS AUTHORIZATION FOR WASTEW.A.TER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
Mdyafy°�r,Jn;GrL�+ i/ ��� ,
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
r
RESIDENTIAL SPECIFICATIaN: BUILDING TYPE # BEDROOMS,# BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes of No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE--__!� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH Y-�e ROCKJ)EPTH J� LINEAR FT. -5 /'J
OTHER?Ie�- 1�$ �1 i'"•' I�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT 't .
r
� r1.
A
+
r.
AUTHORIZATION NO. 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.
DCHD 02/02 (Revise
r ..
/v.
Pernittee's DAVIE COUNTY HEALTH DEPARTMENT 5-r C `v A -Name: (,60A)" t S Environmental Health Section PROPERTY INFORMATION
/��/ P.O. Box 848
Directions to property: f,t, Mocksville, NC :.7028 Subdivision Name:
r Ph ne #: 336-751-8760
?` fG� - ✓ �i SAB *%- /J ' cJ Section: Lot:
d 1/k/f ORIZATION FOR
�I
Ate C%0 WASTEWATER Tax Office PIN:#
�--�— --� SYSTEM CONSTRUCTION -
-A AUTHORIZATION NO: 2110 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 Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(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 .
:RES. ___.. ...... _...._
IDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS,/0# 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 �-?6 ROCK DEPTH O!Z LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
(l/Z%l Gf/i9!!'/ Syf ylni
"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.
OPERATION PERMIT
SYSTEM INSTALLED BY:
17
00
7
00
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME ��P-Io+�' �� R
PHONE NUMBER
ADDRESS %D a I -r , y SUBDIVISION NAME
a
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED )0 --"-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
Rev. 1/93
CZ,
Parcel #: J50000000501
Davie County, NC - Basic Estate Search
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Parcel #:350000000501
Account #:82525039
Owner Information Tax Codes
ROTTS MARK ALAN ADVLTAX - COUNTY T
1027 US HWY 64 EAST FIREADVLTAX - FIRE TAX
OCKSVILLE NC 27028
Property Information
Township
(Units/Type): 1.690 AC
Ess:1027 E US HWY 64
MOCKSVILLE
6,27
nd•
Deed Information
Local Zoning
Pate: 08/2005 Book: 00622 Page: 0855
Plat Book: Page:
ssessed:
8867
Deferred:
Legal Description
PIN
1.907 AC HWY 64
5748419977
Property Values
ulldin :
62,15 0011
BXF:
6,27
nd•
2025
arket:
8867
ssessed:
8867
Deferred:
Sales Information
No. Book Paye Month Year Instrument Qual/UnQual Improved Price
1 00622 0855 08 2005 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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000rjt�_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.daviecountyne.gov/itsnetfView.aspx?prid=1472122 6/30/2016