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4489 Hwy 64WDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems:.;, j ��,, .! lir �r, Permit Number Name �� L�✓1 /'% �'s-v : . ,_/ Date % - '"S y NO 7903 k .Locatio Subdivision Name Lot No. Sec. or Block No. Lot Size /iI— — House — Mobile Home Business -- Industry No. Bedrooms • —.No, Baths _-- No. in Family 7 _ Public Assembly Other Garbage Disposal YES ❑ NO [.l'' Specifications for System: Auto Dish Washer YES ❑ NO Auto Wash Ma^hine YES p' NO ❑ �'r%'�,r`.r Type Water Supply ,_ A/' // *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. qtr-! a Improvements permit by —_J) *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: `J%1(C% Final Installation Diagram: System Installed by 1 9 o rhQ �It) toll VFX 1 Certificate of Completion `_�� 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County HealtA Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address 11�1,f 2. Name on Permit if Different than Above 3. Application for: e 10 lea t ❑ General Evaluation 4. System to Serve: ❑ House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision Home Phone ,7ayi 5 Business Phone OW) A 3 019-eptic Tank Installation Permit 2'Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown No. of People > No. of Bedrooms 3 No. of Bathrooms C2 Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers. No. of Showers Water Usage Figures, 7. Type of water supply: ❑ Public a Private 8. Property Dimensions / Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If +roe what final Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes 2 -No ❑ Community *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: 3 C! r 1, ue Var o 1 / e P- a f t e r )�IA e It-,dse RJ, 4 6 y crDssforAS. B-�,- This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. 1;2- -4�?3-rs- DATE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: V1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1193) G> i, APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested /Byy Mailing Address Lpl,w ice, o wggl 2. Name on Permit if Different than Above 3. Application for: general Evaluation 4. System to Serve: ❑ House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People _ No. of Bedrooms Home Phone Business Phone ❑ Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers. No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private 8. Property Dimensions Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If vac what tvna9 Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ No ❑ Community *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: 4fi77z- 6�Z 16-IA19L �,-A Pew R This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD'(1193) Davie County Ykalfif De ar lmenl and ome ualti4 encvy 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.5985 January 13, 1995' Mandie O'Neal 4489 U.S. Hwy. E4W. Mocksville, NC 27028 Re: Site Evaluation Highway 64 West Dear Ms. O'Neal: As rea%.ested, a representative from this office visited the aforementioned site on January 11, 1995. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable in the front for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure Parcel #: J100000014 Davie County, NC - Basic Estate Search .Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Man for this Parcel View Tax Bill Information Parcel #:1100000014 Account #:82529153 Owner Information Tax Codes DVLTAX - COUNTY TA �F�IREADVLTAX- FIRE TAX ANIEL MARK S& DANIEL TAMMY B 89 US HIGHWAY 64 WEST MOCKSVILLE NC 27028 BXF• Property Information Township Land (Units/Type): 0.730 AC liAddress: 4489 W US HWY 64 CALAHALN 79,15 ssessed• Deed Information Local tonin ate: 01/2008 Book: 00743 Page: 0470 Plat Book: Page: Legal Description PIN 1.36AC HWY 64 19828000 4797 -59 -2470 - Property Values uiidin : 60,72 0011 BXF• 2,63 nd• 15 80 arket: 79,15 ssessed• 79,15 efenred: Cl Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00194 0774 05 1997 WD Unqualified Improved 16,000 2 00743 0470 01 2008 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 W-1 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?grid=1457737 7/12/2016