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3282 Hwy 64E (2)HEALTH DEPARTMENT RELEASE �vJ �5tAlgv Davie County Health Department 210 Hospital Street " P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: James Sparks Address: P38Wwy 64 E City: Advance State/Zip: NC 27006 Phone #: �(L336)�998-21�03�� Address 3282 US Hwy 65 East Road # Advance NC 27006 *Structure: SINGLE FAMILY # of Bedrooms: # of People: *Water Supply: N/A Basement: ❑ Yes ❑ No *Proposed Improvement: Adding front porch PERMIT VALID 0 6 a 3/ a 0 1 4 UNTIL: "/Property Owner: James Sparks Address: 2382 Hwy 64 E City: Advance State/Zip: NC 27006 hone #: (336) 998-2103 Property Location & Site Information Subdivision: Phase: Lot: Township: Directions Hwy 64 East, on right before Hwy 801 S. Type of Business: Total sq. Footage: No. Of Employees: Characters Remaining 750 This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? Oyes ONO "Applicant/Legal Reps. Signature: *Date: *Issued By: 2140 - Nations, Robert 49 *Date of Issue: 0 6 a 3 a 0 1 4 Authorized State Agent: **Site Plan/Drawing attached.** (& Hand Drawing 0 Import Drawing Drawing Type: HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street t P.O. Box 848 Mocksville NC 27028 Health Department Release CDP File Number: 139258 - 1 County File Number: Date: 06 /a3/ a 0 1 4 O Inch Scale: O Block :--_ft. O N/A Drawing Type: HEALTHDEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release Page 2 of 2 CDP File Number: 139258 - 1 County File Number: Date: A 6./ .. 3/ 2 0 14 Davie County Health Department 1836 Health Section • P.O. Box 848 ,,. 210 Hospital Street„, Y p Courier # : 09-40-06 kl Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodelin Reconnection Name: Phone Number J%yCT !V-3 (home) Mailing Address: 7% ili (Work) Email Address: W Detailed Directions To Site: /,// '* /»r/e /�Tc�J'c'- Property Address: ' J af- rZWV L(L`j t -- Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under; / Date System Installed (Month/Date/Year): 1q,10 J Number Of Bedrooms: Number Of People: Type Of Facility: Is The Facility Currently Vacant? 'Yes y Yes ( ) If Yes, For How Long?. Any Known Problems? Yes (No / Iff Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: �f9 rr i'1 /—Oy �u Number Of Bedrooms: Number of People_ Pool Size: Garage Size: Other: Requested By: /G !� �11 L90 60Date Requested: CjC (Signature) For Environmental Health Office Use Only Ap roved Disapproved Environmental Health Specialist Date: *Thesigning of this form by the Environmental Health Staffis in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash - Check Money Order # _Amount:$ ate: -�3a Paid By: Received By:_ Account#:. I Invoice #:_ DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) - DIRECTIONS TO SITE i - -/ ONE NUMBER BDIVISION NAME DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS �NUMBER PEOPLE SERVED TYPE WATER SUPPLY ---,Pe// SPECIFY PROBLEM OCCURRING DATE REQUESTEDg�INFORMATION TAKEN BY,-�� This is to certify that the information provided Is correct to the best of my knowlgd� and that I understandIaresponsiblefor all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 DAVIE COUNTY HEALTH. DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage SystemsPermit Number . Name J�;A lll-r Vfo? llivlel,1 Date r� l%—�5� N2 7918 Location Subdivision Name Lot No. Sec. or Block No. Lot Size _— _ Houser `� Mobile Home _ --_ Business -- Industry No. Bedrooms _.No. Baths _g — No. in Family Public Assembly Other Garbage Disposal YES ❑ NO p-' Specifications for System: Auto Dish WasherYESNO ❑ Auto Wash Ma':hine YES g�� , NO ❑ Det 1K1 F 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 e ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS. PERMIT/LAYO T BEFORE'INSTALLING THIS SYSTEM. Improvements permit by *Contact a representative of the Davie County Health Department for final Inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634.5985.y76v; Final Installation Diagram: System Installed by — Certificate of Completion �U' 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. , / 4 - X� \ «s i MENT t DAVIE COUNTY HEALTH DEPART x - _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTIf Issued in Compliance With Article IIof G.S. Chapter 130a Sanitary Sewage Systems ,r1'y; Permit Number �� Name _�,j.f>��>r,r�. /%� /:iv iV f'1'., Date ?�'r' `� ' %� 2 7918 . ,Location. — 328 Z h5 fl�I fl � �l� Subdivision Name Lot No. Sec. or Block No. Lot Sie - — — House,-- Mobile Home ---_ Business -- Industry No. Bedrooms—. No. Baths—c=� — No. in Family �— Public Assembly Other Garbage' Disposal YES ❑ NO Q� Specifications for System: Auto Dish Washer YES NO ❑ / Auto Wash Ma^hine YES NO ❑ dG' Type Water Supply elf __. _-- --- �} , j,�, '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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. ,i Improvements permit by —� `Contact a representative of the Davie County Health Department for final Inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.7;1,1�0 Final Installation Diagram: System Installed by — `( y Certificate of Completions _-- 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 eny givert–;J&i6d of time. ; Parcel #: J700000104 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mat) for this Parcel View Tax 6111 Information Parcel #:3700000104 Account #:69482000 Owner Information BXF• Tax Codes Land• PARKS JAMES L & SPARKS TAMARA W Market: ADVLTAX - COUNTY TA ssessed: 282 HIGHWAY 64 EAST Deferred: FIREADVLTAX - FIRE TAX DVANCE NC 27006 Property Information Township Land (Units/Type): 1.390 AC FULTON [Address: 3282 E US HWY 64 Deed Information Local Zoning Pate: 01/1900 Book: 00119 Page: 0815 Plat Book: Pa e: Legal Description PIN 1.48 AC HWY 64 5777267971 Propertv Values uildin : 77,04 BXF• Land• 2391 Market: 10095 ssessed: 10095 Deferred: Sales Information INo. Book Page Month Year Instrument Qual/UnQual Improved Price I 1 00119 0815 01 1900 WD Unqualified Vacant 0 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oo°U it 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/itsnetfView.asvx?prid=1468605 6/21/2016