4301 Hwy 801N/ Qv r ?Sf a ...,.H v':" -h �.+yi': r.:'t. L a - h '•`i'1" 4 c' x y E .i 5 df "�h,'� `1 i a E Ctr' y <; • r i ..£�'y�, i
Z DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION
NTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
/j Sanitary Sewage Systems/ Permit Number
V /4
_ Date,/� N 2 6 40 3.
Location rvwt�����i��
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No.'Bedrooms? _ ? .NO. Baths No. in Family
Garbage Disposal YES. ❑ NO .❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma^hive YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not install
This'permit is subject to revocation if site plans or the intended
0�1
from date of. issue.
Improvements permit by _ ,l
*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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram:
led by.
Certificate of Completion Date i
"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.
0�
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
//,Grp*
NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
iOT
Sanitary Sewage Systems �/ Permit Number
U x `Name 'f�t1'ff' /��, ✓" � S f .l �'�_ Date Z �Z ;�� 0
Y �-=-, N- 640
. Location ,rn,'}✓ 7
A
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �''� Mobile Home _ - Business Speculation
01
No. Bedrooms ' .No. Baths _ No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma shine YES ❑ NO ❑
Type Water.: Supply _
�/L�DX 3X >✓ "
'This permit Void if sewage system described below is not installed �th t ye rs from date of issue.
This,'permit is subject to revocation if site plans or the intended use ch (jai
4
Improvements permit by
"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 day of completion. Telephone Number 704-634-5985.
TAT Y
Final Installation Diagram:
led by
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 Health Department
Environmental Health Section 1 n
t P. 0. Box 665 A
Mocksville, NC 27028'�f
1. Application/Permit Requested By
Mailing Address PN -,p 377
Home Phone ( �`1 33 ��l Business Phone 1z7q—
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation
R-�/Tank Installation
5. System to serve: 0/"H Mobile Home 0 Business
L] Industry u Other Unknown
6. If house, mobile home: Subdivision Sec. Lot#
No. of People Lf Dwelling Dimensions
No. of Bedrooms Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
(Washing Machine ,ly Dishwasher 0 Garbage Disposai
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
8. Type of water supply: 2/public 0 Private 0 Community
9. Property Dimensions ' A 4S, &AsA-d
10. Sewage Disposal Contractor oarnffian �_ rte_ e1 S
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? Yes ��.-0n� No
If yes, what type? t &;tk4Q6YK.
*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.
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
a ts,C�, s ala . J-,
` _ .
Directions to Property: - IL
✓�+��-Saj- c c3w�@X Leu.
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
j ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, R 0. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
nLOATjON QF��iRZI':l �w DATE RECEIVED
s 4- (office use only)
QtsJ no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
OY& no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Departmentto enter upon the above described propertyand conductall
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
q -41-9i
DATE SIGNAT19RE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation resu rom the above described property to the following:
Owner only
— Owners designated representative
Anyone requesting results
— Only those listed below
C<
DATE SIGNA RE
DCHD (11 /84)
Parcel #: B300000069
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: B300000069 Account #:69905000
Owner Information
Tax Codes
ADVLTAX - COUNTY T
READVLTAX - FIRE TAX
ILLMAN JAMES L & SPILLMAN ROBIN C
[301NC HIGHWAY 801 NORTH
OCKSVILLE NC 27028
BXF•
1,71
Property Information
Township
Land (Units/Type): 2.526
[Address: 4301 N NC HWY 801
CLARKSVILLE
ssessed•
87,82
eferred:
Deed Information
Local Zoning
Pate: 07/1984 Book: 00123 Page: 0628
Plat Book: Page:
Legal Description
PIN
78 AC HWY 801
69905000
Property Values
Building:
54,28
BXF•
1,71
Land:
31,83
Market:
87f82
ssessed•
87,82
eferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00123 0628 07 1984 WD Qualified Improved 40,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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OZ �11-
000ril;-I's
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/itsnetfView.aspx?prid=1478189 9/15/2016