388 Hwy 801NPernuttee'sDAVIE COUNTY HEALTH DEPARTMENT
Name: ' O, ` Ct V V1-' V\ Environmental Health Section PROPERTY INFORMATIO
L` G �- -4 (� P.O. Box 848 d'
Directions to property: L Mocksville, NC 27028 Subdivision Name: V
i
Phone #: 336-751-8760
. C) n Section: L Lot:
i, } t AUTHORIZATION FOR �L+ � 7� SU
WASTEWATER Ta Office PIN:# J
SYSTEM CONSTRUCTION / -
AUTHORIZATION NO: 002878 A Road lame f �! �4/ Zip: 7 6,C 6n
**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
Office when applying for Building Permits.
(In complian5e wo Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/ 7—�C IS VALID FOR A PERIOD OF FIVE YEARS.
AL HEALTH §PECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS #OCCUPANTS -I GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
1�1 aee-e5 `'dW-e tl 3 � D
LOT SIZE �'' 1 'TYPE WATER SUPPLY yy DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE r/
SYSTEM SPECIFICATIONS: TANK SIZE k � GAL/ PUMP TANK --,OAL. TRENCH WIDTH _ ROCK DEPTH (LINEAR FT. Y�
OTHER 6r 36o' 1
REQUIRED SITE MODIFICATIONS/CONDITIONS: Lt 5 1
0
TMENTTERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
'7 C e dr
'0APJ - _,
•i 1
t 3 t
Ai
AUTHORIZATION NO. 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.
DCHD 02/02 (Revised)
emuttee's�`' - DAVIE COUNTY HEALTH DEPARTMENT
s' Environmental Health Section PROPERTY INFORMATION
Name:
Qa�', „E, P.O. Box'848 '
. ;Directions to r6perty: �'' �' (.� ' ( Mocksville, NC 27028 ., Subdivision Name: t
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER U
SYSTEM CONSTRUCTION Tax Office PIN:#
k - -
oName: f" l / zip:
UTHORIZATION NO: 002878 lei .Road d 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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In complian a wi Article 11 of G.$. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
*** OTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
kk
LOT SIZE "� "� TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) D NEW SITE REPAIR SITE v�
SYSTEM SPECIFICATIONS: TANK SIZE ` k GAL' Pl MP TANK /�/ _ AL. TRENCH WIDTH ROCK DEPTH _ 'LINEAR FT.
OTHER D 360
REQUIRED SITE MODIFICATIONS/CONDITIONS:
PERMIT LAYOUT '
(I�C,CfiC1 1
C., rr,
� � r a ��� G i -� O
J� C t�'t'(�G�r.•►�i
V olh
3
0
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
"U t111
OPERATION PERMIT } G
SYSTEM INSTALLED � BY: � � /� �_SL in�
e7
-
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: !9G
**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 01102 (Revised)
.4&
NAM
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER �����
ADDRESSIfO,464�9flY N61w�( kol N • SUBDIVISION NAME
N(VA'le� Z 704 LOT #
DIRECTIONS TO
/171 _ \. •
G
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ON
d
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY Se— NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED /
TYPE WATER SUPP '''"`�"/ SPECIFY PROBLEM OCCURRING 1�rn0/V!'l2S
444. _AU/"AiAlll b/24iA/ "L"/1.
DATE REQUESTEINFORMATION TAKEN
This is to certify that the information provided is correct to the best of my knowledge, and th I un ers d I am resupole to I charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
_�4 1o • rr— — —
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http:llmaps.co.davie.nc.us/GoMaps/maplIndex.cfm?mainmapservice=gomaps&CFID=412.... 6/13/2008
Parcel #: C700000113
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Parcel #: C700000113
Owner Information
WARDENINC
01 SOUTH WESTVIEW DRIVE
INSTON SALEM NC 27104
Property Information
nd (Units/Type): 1.830 AC
ddress: 388 N NC HWY 801
Account #:82520035
Tax Codes
ADVLTAX - COUNTY T
FIREADVLTAX - FIRE TAX
Townshi
FARMINGTON
Deed Information Local Zoning
ate: 01/2003 Book: 00458 Page: 0565
Plat Book: Page:
Le al Description PIN
117 AC HWY 801 5872162350
Property Values
uildin :
36,43
BXF•
Land:
322 85
Market:
359 28
ssessed:
359,28
efenr,
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 1999E 0227 07 1999 WL Unqualified Improved 0
2 00458 0565 01 2003 WD Qualified Improved 220,000
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=1473962 9/20/2016