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AUTHORIZtrTION NO: 0579 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
1'ermittee's P.O. Box 848 ,
`Name: 't E ,y1�0 C.4� Mocksville, NC 27028 Subdivision Name:
'' Phone #: 704-634-8760
Directions to property:, 5,,��gW Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION 1) -
-
:� Road Nare•. (Q GV• Zip: Haig
**NOTE** This Authorization for Wastewater.System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any. Building Permits. Jbis 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 VALIDFOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH S dALIST DATE ISSUED
-_- '�«. ;'Ft" 1'y -„'^+.+.s, ? ,�^�n+ r r kb :.t - .'y�'. f`}'� ,r r,.e ,r: ;a.<' t•. .v. ,.9.. v<r
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DAVIE COUNTY i 2 r
r du >
TY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
0�D L(J Subdivision Name:
64T tions to property b 414 Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# - -
Road Name. :. Zip.'Y
**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.
(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
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 # 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-:6AL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH /tel LINEAR Ff.
i
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**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) 6348760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION N�7 1 ` OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE.I 1 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)
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..a
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND. OPERATION PERMITS PROPERTY INFORMATION
N Pernfittee's ��
:Name �
.,,�.f <'� t.1:3 r Subdivision Name:
Directions, to property: Section: Lot:
IMPROVEMENT
r ' PERMIT Tax Office PIN:#
Road Name: �t't�+✓• An.
**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.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT LS SUBJECT TO REVOCATION IF SITE
.�,. 2r x:°'1*, :.•t.,f' � ;» +a`/'��f-*�-�`�'� ra.eu��vicinr.u�iri�L�La���a,ru�l�v�.ivunr�r�ir.��r�ar.ac
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS S? # BATHS 7 # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY 4� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZFI AL. PUMP TANK GAL. TRENCH WIDTHS C' ROCK DEPTHLINEAR FT.
OTHER h
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 (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION N(} , 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.
ncm nv(m meviaedl
l
r DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION call dhf.i khe Pisa
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) .44
e? -
NAME
NAME S c, Ki L Sn rw PHONE NUMBER
ADDRESS y a b a IAS. 11wy 64 W MocK 2?02k SUBDIVISION _NAME
LOT #
DIRECTIONS TO SITE le,4neA4., --4w - 3 rkt o+, R.'� 4w
L � r V
DATE SYSTEM INSTALLED �' NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �Mk_ NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED fl
TYPE WATER SUPPLY
1�OunTV S1PECIFY PROBLEM OCCURRING 6vtLf Nappc.Q up-
r't &JV 4v ACU oh�D 1 � 041 - Lu;- Y1 ICt d- d) 1' e1CC L SL
DATE REQUESTED //-/;L-C/6 INFORMATION TAKEN BY 21^ -
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 #: J10000001702
Davie County, NC - Basic Estate Search
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Vie�V Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:J10000001702 Account #:82517023
Owner Information
uildin :
Tax Codes
BXF:
NOW STEPHEN C & SNOW JACQUELINE C
Land:
ADVLTAX - COUNTY T
Market:
202 US HIGHWAY 64 WEST
ssessed:
ViREADVLTAX - FIRE TAX
[Deferred:
MOCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 1.350 AC
CALAHALN
ddress: 4202 W US HWY 64
Deed Information
Local tonin
Pate: 04/2002 Book: 00419 Page: 0125
Plat Book: Page:
Legal Description
PIN
1.35 AC HWY 64
4798638214
Property Values
uildin :
184,99
000
BXF:
14,030
Land:
21,00
Market:
220 02
ssessed:
220 020
[Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
1 00419 0125 04 2002 WD Unqualified Improved 0
2 00169 0182 06 1993 WD Qualified Vacant 28,500
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=1466491 7/13/2016