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2105 Hwy 801N4errnittee's 1'� "-� DAVIE COUNTY HEALTH DEPARTMENT Name::. at`�-t" '-%! ^� Environmental Health Section . PROPERTY INFORMATION P.O.`Box 848 Direetis perty: VAI 6-TOIJMocksville, NC 27028 Subdivision Name: `+ ` Phone #: 336751-8760ls ; Section: Lot: 1 AUTHORIZATION FOR Tax Office PIN:# - - }} SYSTEM CONSTRUCTION •i1 ra pd. a L. ate ' /.los- or- til-i�(��� %AUTHORIZATION NO: A Road Name: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the,Davie County Environmental Health Section prior to issuance of any Building Permits. This Fon-n/Authorization Number should be presented to the Davie. County Building Inspections Office when applying for Building Permits. (In compliancepith Ar-tic4ej 1 of apter OA; Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE:* Pt.THIS AUTHORIZATION; FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.` EN IRON AL EATF SPECIALIS DAT ISSUED a } RESIDENTIAL SPECIFICATION: BUILDING TYPE_ '# BEDROOMS # BATHS #OCCUPANTS 'L' GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No ff�� �/��;J�/ ,11!���S(\ �j� j LOT SIZE 0'r✓, A"'TYI?E WATER SUPPLY WrDESIGN WASTEWATER FLOW (GPD) -- NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �' ROCK DEPTH I Z LINEAR FT.� ' OTHERtL-1 REQUIRED SITE MODIFICATIONS/CONDITIONS: i **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 (336)751-8760., OPERATION PERMIT SYSTEM INSTALLED BY: �. V; v- AUTHORIZATION NO. OPERATION PERMIT BY: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE AT THE SYSTEM DESCR ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BETAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 07/02 (Revised) i V.' 3 A t O . & 1 Ae-2-� f DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �'�-�"� t ",*313Y ` APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)��`; NAME 6VD��^-�� �„a ar1A•.� 5`7Avl'TOz PHONE NUMBER ADDRESS �lOs ��— ^� SUBDIVISION NAME t 4 _pa I.tiit, rl _ Q J►J , "% LOT # DIRECTIONS TO SITE -`� i'L"''D �r,?" © �J r 2�� N °'� DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY tOJS& NUMBER BEDROOMS 2 NUMBER PEOPLE SERVED 2 TYPE WATER SUPPLY CA)kpr� SPECIFY PROBLEM OCCURRING DATE REQUESTED "� �j I�3 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 Parcel #: C500000091 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Q 0 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: C500000091 Account #:21182000 Owner Information uildin Tax Codes BXF: ILLINGHAM NORMAN & DILLINGHAM LINDA nd: ADVLTAX - COUNTY T Market, 900 MILL RUN ROAD ssessed• READVLTAX - FIRE TAX efenred: ERRELL NC 28682 Property Information Township nd (Units/Type): 0.810 AC FARMINGTON ddress: 2105 N NC HWY 801 Deed Information Local Zoning Date: 12/1994 Book: 00177 Page: 0685 Plat Book: Page: Le al Description PIN 1.81 AC HWY 801 5842976699 Property Values uildin 65,67 BXF: nd: 20,72 Market, 86 39 ssessed• 86,39 efenred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00177 0685 12 1994 WD Qualified Improved 50,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oA. 000tivi-1-1- 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/itsnet/View.aspx?prid=1469266 8/31/2016