3320 Hwy 801N1?erzttees, DAVIE COUNTY HEALTH DEPARTMENT
.0-'L ." Environmental Health Section PROPERTY INFORMATION
�tl�'t"" P.O. Box 848 /� o(, 8": - 7"
Directions to property: *. Mocksville, NC 27028 Subdivision Name: / /
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER: Tax Office PIN:# -
SYSTEM CONSTRUCTION
ALITHORIZATION NO: 2694 A Road Name: -�5 t ` Li 01-1
**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 Form/Authorization Number should be presented to the Davie County Building Inspections
Officerwen applying for Building Permits.
(In compliance w(Article; 1 of .S: Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
j***NOTICE***.THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
%? C IS VALID FOR A PERIOD OF FIVE YEARS.
t
ENVIRONN;NTAL`H AL 'SPE` IALIST) U D r
RESIDENTIAL SPECIFICATION: BUILDING TYPE NDLYL- # BEDROOMS -7 # BATHS # OCCUPANTS ' GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE T # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY SA-L-DESIGN WASTEWATER FLOW (GPD) ANEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GALS. .TRENCH WIDTH ROCK DEPTH LINEAR FT,
OTHER r�'-�I�ay3�tf]aX.l�i1
REQUIRED SITE MODIFICATIONS/CONDITIONS: IoST6,AI M IfAn4tot9`2. _%1c'"1 I'1 a 1 r•� fid/ j' 'm►
IMPROVEMENT PERMIT LAYOUT
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**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:
OPERA ION P MIT, GC-�
SYSTEM INSTALLED BY:
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1,-� - ia�o c�aL , ►�4sAvraa�
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: '
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS D CRIBED ABOVE HAS EN INSTALLED IN COMPLIANCE
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WITH ARTICLE I1 OF G.S CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT SPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
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DIRECTIONS TO
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER 9d
% Cr Y'f-L� '0 A) SUBDIVISION NAME
7 a ,�a'� W /-j
LOT #
/l Ey t -
DATE SYSTEM INSTALLENAME SYSTEM INSTALLED UNDER �1°� eel/CA-
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED 2-
TYPE WATER SUPPLYI,-L � SPECIFY PROBLEM OCCURRING
DATE REQUESTED ( mac' a INFORMATION TAKEN BY 0 -
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 #: C400000053
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map
for this Parcel View Tax Bill Information
6114
Parcel #: C400000053
Account #:50980000
Owner Information
22440
Tax Codes
28967
ILLER L GENE SR& MILLER MARIE M
9536
ADVLTAX - COUNTY T
19431
320 NC HIGHWAY 801 NORTH
0
READVLTAX - FIRE TAX
10 1995 WD
OCKSVILLE NC 27028
Vacant
0
Property Information
Township
nd (Units/Type): 23.302
Edress:
FARMINGTON
3320 N NC HWY 801
Deed Information
Local Zoning
Pate: 10/1995 Book: 00188 Page: 0911
Plat Book: Page:
Legal Description
PIN
HWY 801
5832471077
Property Values
uildin :
6114
BXF•
4,13
nd:
22440
Market:
28967
ssessed:
9536
eferred:
19431
Sales Information
No. Book Page
Month Year Instrument
Qual/UnQual
Improved
Price
1 00056 0368
03 1955 WD
Unqualified
Vacant
0
2 00058 0043
12 1955 WD
Unqualified
Vacant
0
3 00188 0911
10 1995 WD
Unqualified
Vacant
0
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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=1457615 9/22/2016