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3065 Hwy 64E
r r D VIE•COUNTY HEALTH DEPARTMENT Permittees ` ;� PA `•; .< l ' PROPERT INFO MATION L` ` 1 7{ Environmental Health Seetion ��� a P.O. Box 848:�o Directions to propeitq: ^`• (G� �' !.»51;x" I' -Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 AUTHORIZATION FOR Section: Lot: WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# - — 2301 ^' r r• tr Z 0� AUTHORIZATION NO: A Road Namtrq p: **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 BuUding Permits. (In compliance % iiWArticle l I of,G.S. Chapter Q, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) L,***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �.� IS VALID FOR A PERIOD OF FIVE YEARS. ENVI MEN7� H ALTH SPE ALIST( i� DAT ISSU D RESIDENTIAL SPECIFICATION: BUILDING TYPE _& BEDROOMS # BATHS_ _ # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDU e o LOT SIZE n HYPE WATER SUPPLY 0,COYDESIGN WASTEWATER FLOW (GPD) + Y) NEW SITE REPAIR SITE _ SYSTEM SPECIFICATIONS: TANK SIZE ----GAL PUMP TANK GAL.. TRENCH WIDTH _ROCK DEPTH LINEAR Ff. 1 OTHER REQUIRED SITE IMPROVEMENT PERMIT LAYOUT t�. M -T-T 6 W I - hj **CONTACT A REPREATIVE OF THE I AVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 9:30 A.M. OR 1:00 - :30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERM / +t�' • SYSTEM INSTALLED BY: L�j�a 4 v joy AUTHORIZATION NO. _ 4 — OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SfSltM DESCRIBED A E HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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. ocaD ozm (Revs" l QL ., i:b, , /, 7''yr 4.<.. 1 5 �, , µy ."."'*'ewZv ,Q �'ih ':+�+a.. r<.•..'.+.< rt;,:, .. ,i:: i ,. ii v ;.,. �. -.r+ .•t - s'.: :� ",.,- Pcrmittee's f '! DAVIE, COUNTY HEALTH DEPARTMENT 111 �Namer Environmental Health Section PROPERTA INFORMATION Jri t f -par t� P.O. Box 848 Directions to property �? Mocksville, NC 2702E Subdivision Name. Phone #: 336-751-8760 3F . Section: -"Lot: AUTHOMZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION NO: 2301 A Road Name: a � Zi .- `**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 Bu' dine Permits. (In corrlpliance�wit Artielejl 1 of�G.S. Chapter OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) { j ? ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION .: •-� I �I�SIL) IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONME &H ALTH SPE Ar DAT ISSU D RESIDENTIAL SPECIFICATION: BUILDING TYPE S# BEDROOMS # BATHS # OCCUPANTS_ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE �U i%-� YPE WATER SUPPLY _Cj2a/ DESIGN WASTEWATER FLOW (GPD) �o NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH _— LINEAR FT. , OTHER .,REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT lit=om.�t •i� 1 **CONTACT A REPRE NTATIVE OF THE I AVIE 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: J V _ A JAUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S M DESCRIBED A E HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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. .�. x/36 � �'�� � � � � � �� �� � �,�� �'-. � `� �'._�. �yt. � �,�� �: �i���1 � �� � ° �'���� .� �sa � �� � �'� �' i ,.�� � � ���qlil��I� ����I�� �. � �s � ���. �� yj.��„ '������� �'��"�� ��.k�� y. 5 i " �. � II% YI'II I .I a ��&iH 3,.b YF �T'�T�� �# 9ffi^� �@�' � � ��'-� E � r�,..' � �I �� a �� y,/��k a���'s'� ��`� �.�.e.,y"` ,� �,; �. 6 .� " 3 a� � y,^f�, �, �r��g'a� �� �+ �' � � �.+N�::. �' �i '��d � -,���t�2 �""� bk � �� '8�a y � 6'�r �,,w,� �E n�x�. � - �t � ,- � � �(s ��� K�r�� � �'� � � �� �5 ��u�M�" , �'�'���v«rf,��`'3��'���� ��3�`�#.'a �' �,�% ._. � �� ����a� � ���£��� # � � � "'. �� z r �& �.���,���,:�� ��� �� �,�, ,��, , z..,�. �, ��ro� f��a�2� � � '.� � ��. � ���.%,�'sk�'a�p3�' �r .r� ,�� - ��t� , �-s .{ »�,� � ��g � �y r� ���� ��;���`� ;6 "�v,.�.»�"���.�'.. �, ^ ,�.��, �t s k �; �,-a.��.�� �� � �,��' gz ,#"��;;�� '.. �_. � �-� b '� .� a " ,� r ��.yv.��� a � �, 'r;, ,���� ��. u � .. �� ,� „�C ����f � ':;;� , �'�# rry� &� -��, a �-� �. ��� '� f8 �i , y'�,� P 1 :t � I� � � �� ��� � �5v'* W��,�`',�*�' � 1. ��P�w... a;� - �, � ^�� � �r .� � t� �� i/ � a � x ;.s�: �� §�� i y�E�, t ��'' �..� . x �e� a n '� �. 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' .� P��"` � :�' e 'a aS�` `����, �a� ���; ��% ��'y s �1 ��_ : :�- �"�" ' ,���� '�,f� �b� Y' ��° �"� � a� `��"`��'� ��,���''��� �� � � rk � �i+�� w,. °� ����`�� 3� �, t ro �� �' _� � + S �� �s� �'�°$�. � �� p"Y�° x�', Y� . . � {Y q� �m�� ��n., � 3 �� ��`�y��a�� 9 �` ��� � �� x �5�� `, 2f �� �- �* ' � �� .: "'"�� .�^� .. ,i . .?. 4.� '�,' ���rW"�#�S F�"e�E�� ,�'/"',�." a, ,�'r, �} ':�f `" � 4 '�r �..��..._s�.,. �...,.,.« ess u�tii�ca- .k,�wfl.,,..��. � s , Y � DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION • APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME �� �PHONE NUMBER ADDRESS �y6 �� SUBDIVISION NAME LOT # T� i' DIRECTIONS TO SITE `� SL / �—� e IZQ 6 DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER c eN s TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING S _ Ld o �� DATE REQUESTED 71 2_//6 FORMATION 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. t 4 SIGNATURE OF OWNER OR AUTHORIZED AGENT �1 Rev. 1193 Parcel #: J712OA0003 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 #:3712OA0003 Account #:8305659 Owner Information Book I Tax Codes 21,72 NG LAURIE ANN& DOUGLAS STANLEY KENNETH Qual/UnQual ADVLTAX - COUNTY T 35,72 11 BURNETT DRIVE 57 44 FIREADVLTAX - FIRE TAX 57,44 UTLEDGE TN 37861 Cl Property Information:9 42,000 Townshi nd (Units/Type): 2.910 AC 0561 FULTON ddress: 3065 E US HWY 64 Unqualified Deed Information 0 Local Zonin Pate: 06/2016 Book: 01021 Page: 0561 0156 08 Plat Book: Page: Qualified Le al Description 55,000 PIN 13.058 AC HWY 64 0886 5777099129 Pro a Values Book Buildin 21,72 BXF: Qual/UnQual nd: 35,72 Market: 57 44 ssessed• 57,44 eferred• Cl Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1. 00994 0358 07 2015 WD Unqualified Improved 42,000 2 01021 0561 06 2016 WD Unqualified Improved 0 3 00165 0156 08 1992 WD Qualified Improved 55,000 4 00492 0886 06 2003 WD Qualified Improved 94,500 5 00658 0100 04 2006 WD Qualified Improved 115,000 View, Prol2erty Record for this Parcel View Map for this Parcel View Tax Bill Information 0 Page 1 of 1 oN-l� L-OUt,- 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=1493794 6/22/2016