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� {'AUTH�ORIZATio1v NO: '� �" � .VIE C NTY HEALTH.DEPARTMENT � 'Z�"?`3�00
i t7 7�� DA OU � �
Environmental Health Section � PROPERTY II�TFORMATION
Permittee ti� �"'^ P.O: Box 848
Name: �, '�.� �. %- S Mocksville, NC 27028 ' Subdivision Name:
. . , ' . r '!:�. -, . , . . . ' , `, . . .. ,. . .
j � - Phone # '336-751-8760
v,�, :; Directions to property: �-' '�%�,/�� '.'. - Section: Lot:
��,� f _ � _ AUTHORIZATTON FOR ` ; :
',� �,.�/,.� ri G.- � `.�i ` .' '' WASTEWATER .Tax Office PIN:# - -
SYSTFM CONSTRUCTION :
, f� ���,'�: �/%/, ��t ���� Road Name: Zip:
**NOTE** Tliis Authorization for Wastewater System Constn►ction MUST BE ISSUED 6y the Davie Counry Environmental Healtli Section prior
` to issuance of any $uilding�Permits. This �'orm/Authoniation Number should be presented to the Davie County Building Inspections ;
. . , Office when applying foi Building Permit�s: . : . ` ; ,.< ,r :
'(In compliance with Article 11 of G.S; Chapter 130A,'.Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
� �. .
� � j � '' �.i' : , :'� F ` ' ,***NOTICE*** '�HIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
'��,j � ' ! ' ` , /,%- � f „, 'IS VALm FOR`A'PERIOD OF FIY� YEARS.
t �. ENVIRONMENTAL HEALTH' ALIST, ' DATE ISSUED �; ''; �
�
� . �
q
� q' yd v -+s ` F e �.<; r rte: ° ,"�"�; �w r� . .,.._ _ � e* o ._- ryk c.�.: ,4-' " ,.. -•>:' ,'; .. �
78 A DAVIE COUNTY: HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
NatrIe�r"r, '.. . r i , < Subdivision Name:
Irectrpns to property; . Section: Lot:
1AVROVEMENT
PERMIT Tax Office PIN:#
r`. �'✓ : r / "r Road Name Zip:
'**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
constructionfinsmIlation of a system or the issuance of a building permit.
(In compliance with Article 1 I 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 TYPEE,' # PEOPLE # PEOPLEISHIFr # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY/DESIGN WASTEWATER FLOW (GPD)' (::v Yom) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH rROCK DEPTH ,LINEAR FTls
OTHER
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 # IS4394)tT4-r d"
xxxxxuxxx
3 —9760—
DCHD 05/96 (Revised) ,
6:.;..-4,L.o.i,.yY�r•.""4 ysC"✓3 ._ �-'r"'^"isf'=f°Cg,.. m.rg•'r�''`=a"k td .v +�'��"7 �:.w.F� A�,. wtie'w. . • _i,:. r ::;;q ,a_- �: V.
`0 ,� ADAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
`PermittI's
r Name: yt . Subdivision Name:
Directions to property: 2 ' _ 41 Section: Lot:
4,
IMPROVEMENT
PERMIT Tax Office PIN:
Road Name: Zip:
**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)
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) 0 NEW SITE REPAIR SITE
P : SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -.?G ROCK DEPTH LINEAR Fr/—f—V
•ti
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOIJ PPRIIVED EFFLUENT
S) IF 619. FELON FINISHED GRADE*
"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 # IS4704)t34-8 ".—
xxxxxxxxx
IDI—bibu
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO.�–f�— �� LAPERATION PERMIT BY: DATE: n _ �'ou
"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.
DCHD 05/96 (Revised)
}
"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 # IS4704)t34-8 ".—
xxxxxxxxx
IDI—bibu
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO.�–f�— �� LAPERATION PERMIT BY: DATE: n _ �'ou
"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.
DCHD 05/96 (Revised)
A
NAME i6i X�
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER Pr— U — 0'2CI
ADDRESS SUBDIVISION NAME
elf '4/'c' LOT
DIRECTIONS TO SITE / Sr kaf 6`� P /'_ �' C/
M
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY f/yks NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY - SPECIFY PROBLEM OCCURRING z' ;oV'f!S e2 -4-c-_
DATE REQUESTED, ��ly Ga 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. 1/93
irlJyyac ���o y ,qce
Parcel #: C600000069
—4avie County, NC - Basic Estate Search
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Parcel #: C600000069 Account #:82532174
Owner Information
Buildin :
Tax Codes
BXF•
YERS 30YCE K
14`111DVANCE
Land:
ADVLTAX - COUNTY TA
Market:
52 NC HIGHWAY 801 NORTH
FIREADVLTAX - FIRE TAX
Deferred:
NC 27006
Property Information
Township
nd (Units/Type): 0.500 AC
FARMINGTON
ddress: 1452 N NC HWY 801
Deed Information
Local Zoning
Pate: 03/2009 Book: 2009E Page: 2746
Plat Book: Page:
Legal Description
PIN
1.50 AC HWY 801
5852788892
Property Values
Buildin :
81,5601
BXF•
01
Land:
Market:
1essed:
1d8O
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00066 0378 03 1963 WD Unqualified Improved 0
t 2009E 2746 03 2009 WL Unqualified Improved 0
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=1460173 9/14/2016