2380 Hwy 64W.br, kid
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**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/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)
NAME �.� / PROPERTY ADDRESS � > DATE
LOCATION
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER'
RESIDENTAL SPECIFICATION: BUILDING TYPE -�� # BEDROOMS # BATHS # OCCUPANTS, GARBAGE DISPOSAL: Ye6
COMMERCIAL. SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
-LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE fj GAL. PUMP TANK 6R1.. TRENCH WIDTH ROCK DEP H—,OLINEAR FT.
OTHER
REOUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
I'
IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:0-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 834-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
L�
11 ,
C, 1
fn '•�
AUTHORIZATION NO. �.� Y' 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. I
DCHD 10/95
"_' Y ,) Yxya :•'PJ 11..:K.� ":y r.,s L rat.k{s iV
Davie County Health Department
ENVIRONMENTTAL HEALTH SECTION
P.0: Box 665
Nocksville, N.C. 27828
►I I � �6
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRICTION
rid
(Issued in compliance,with Article 11 of
B.S. Chapter 130A''Wastewater,Systems)
***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 ap lying for Building Permits.***
i AUTHORIZATION NUMBER
NAME DATE `5�--'�_! N2 J 1 % 6
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
COMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
i•:
***NOTICE*** THIS AUTHORIZATION FO 5TEWATER SYSTEM CONSTRUCTION IS V FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONENTAL HEALTH OUDALIST, DATE
DCHD 10/95; �r
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) p
NAME s�e l� D PHONE NUMBER � ?19 - �
ADDRESS 4��"�� �� �/7 w SUBDIVISION NAME
Wo c- L LOT #
DIRECTIONS TO SITE (a `T�• �" !'� d u� dA
64-aj
U ?
DATE SYSTEM INSTALLED %:2-- NAME SYSTEM INSTALLED UNDER '
TYPE FACILITYuse - NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY �M KrM i/"aq'-~SPECIFY PROBLEM OCCURRING Gl Eck- e--5� 1-JQ_
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
Rev. 1/83
Parcel #: H2O50B0010
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search Q
Viow'Prpoertv Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:H2O50B0010
Account #:82531797
Owner Information
Tax Codes
WLES-SWICEGOOD COMMERCIAL PR
E�SOCKSVILLE,
ADVLTAX - COUNTY T
4 VALLEY ROAD
FIREADVLTAX - FIRE TAXNC
27028
Market:
Property Information
Township
Land (Units/Type): 1.000 LT
CALAHALN
ddress: 2380 W US HWY 64
00882 0477
Deed Information
Local Zoning
ate: 02/2012 Book: 00882 Page: 0477
Improved
Plat Book: 0004 Page: 098
3
Le al Description
PIN
OT 2 SHEFFIELD PARK
5719540745
Property Values
Buildin :
72,56
BXF•
140
Land:
2500
Market:
98 96
ssessed:
98 96
Deferred:
2
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved
Price
1
00416 0434
04
2002 WD
Unqualified
Improved
0
2
00882 0477
02
'2012 WD
Unqualified
Improved
57,000
3
00123 0271
06
1984 WD
Qualified
Improved
35,500
4
00130 0390
03
1986 WD
Qualified
Improved
43,000
5
00140 0394
10
1987 WD
Qualified
Improved
44,000_
View Prooerty Record for this Parcel View Mao 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/itsneWiew.aspx?prid=1460865 7/14/2016