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138
AUTHORIZATION NO:
. DAVIE COUNTY HEALTH DEPARTMENT
-
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Environmental Health Section PROPERTY INFORMATION
Pernnttee'�
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P.O. Box 848
'Name: + t d
/a/t'� /1,� �-
Mocksville, NC 27028 Subdivision Name.
it
Phone #: -704-634-8760
'
Directions to property:
'Section: Lot:
AUTHORIZATION FOR
WASTEWATER
'- , '-117 f SYSTEM CONSTRUCTION Tax Of P�N:# - -
_5 // p►
Road Name: .. , t0'7 A� • 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 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
u�y�Y
s
DAVIE COUNTY HEALTH DEPARTMENT
-- �►� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
:-::,Narne.' i'./�r f t;c''+ �f� ( ��r irk { - Subdivision Name:
��5�irecions—toproperty:� '�✓'.� P� ' � r'r t � Section: Lot:
IMPROVEMENT
,PERMIT Tax Office P N:#
Road Name: �`7` = Zip:
**NOTE** This Improvement Permit DOES NOT authorize theconstruction struction orinstallation 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
�;r-, t�`' �� 1 ./`,,� , `•... PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING TILE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS a # 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 V
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK'"" GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
i
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT / �r `
\ U
. F
**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.
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 t OF G.S. CHAPTER 130A. SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS". BUT SHALL IN NO WAY BE TAKEN AS A
fa =� DAVIE COUNTY HEALTH DEPARTMENT
�• :` a IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
:�f}r Subdivision Name:
96chbns`to property: 4�" r`.-`
4 . Section: Lot:
EUPROVEMENT
PERMIT Tax Office P N:# - -
Road Name• ' Zip:
M,f
**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.
w (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** TM 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 # BATHS =01? # OCCUPANTS - ='f GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
i
LOT SIZETYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK'GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.��d
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
1
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT AO�FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION:. ELEPHONE # IS (704) 634-8760.
OPERATION PERMIT _ %}
SYSTEM INSTALLED BY: !LJ
/
t
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 05/96 (Revised)
rp,3 y
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
M
PHONE NUMBER �oy- eon 78'
BDIVISION NAME
//,, CJ
�Iho CKs l�% �l e-, /4/c o`� �I �a� LOT #
DIRECTIONS TO SITE
DATE SYSTEN TALLED NAME SYSTEM INSTALLED UNDERv SQw`SZ _ v
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY--- CZ/--�SPECIFY PROBLEM OCCURRING
/,7
NFORMATION TEN B
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. 1193
Parcel #: J600000082
Davie County, NC - Basic Estate Search
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Parcel View Tax Bill
Information
Parcel #:1600000082 Account #:82520342
Owner Information
Building:
Tax Codes
BXF:
AITHER MAGALENE D
IMOCKSVILLE
Land:
ADVLTAX - COUNTY TA
Market:
1938 HIGHWAY 64 EAST
VLS-Sessed:
FIREADVLTAX - FIRE TAX
Deferred:
NC 27028
Property Information
Township
Land (Units/Type): 1.440 AC
FULTON
ddress: 1938 E US HWY 64
Deed Information
Local Zoning
Date: 01/2002 Book: 2002E Page: 0102
Plat Book: Page:
Le al Description
PIN
1.4 AC HWY 64 LOTS 55-64757680679
Property Values
Building:
173,64
BXF:
1,86
Land:
24,33
Market:
199 83
VLS-Sessed:
199,83
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 2002E 0102 01 2002 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnet/View.aspx?prid=1472949 6/23/2016