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5568 Hwy 801S' M i;ern ittee3s DAVIE COUNTY HEALTH DEPARTMENT W( I, Name: hQh ikt Lz u k v --e) Environmental Health Section PROPERTY INFORMATION l aliZlY � ��� P.O. Box 848. Directions to property: Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: t AUTHORIZATION FOR WASTEWATER Tax Office PIN:# 7lr � - -6 y3 r SYSTEM CONSTRUCTION AUTHORIZATION NO: 002821 A ba`8 Eme: i Zip. 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 Office when applying for Building Permits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ..,*NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION / IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 5 F, # BEDROOMS 3 # BATHS _� # OCCUPANTS —� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No 0 ' LOT SIZE (f .y�Lj Q TYPE WATER SUPPLY CO DESIGN WASTEWATER FLOW (GPD).3 (per NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE )CI GAL. PUMP TANK",/ GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fr.. OTHER - E' �, Q C Y 1 Cl LAI r, i T n 6t ' I u i: L 1 G ►1 1 ✓✓ Q' O wr a c �� REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ' ) 2- �N 5 u ✓-� S `� CN cam.. c1 / u► -1 5 (I) CtGN� 1 / 4\ -f o %T0 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: L -Xy qsTb et4A�� 12 LA �s ,5'c� : tv' AUTHORIZATION NO. `— 7 kPERATION PERMIT Y' =k� �-- **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INS WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TRE AN I8P AL SYS' GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIN DCHD 02102 (Revised) %7 n �f 2� /,1, Jt QEPLA12 DATE: 1 ,' / 7S BEEN INSTALLED IN COMPLIANCE ", BUT SHALL IN NO WAY BE TAKEN AS A 6 Zq 1� E�rttiutte s DAVIE COUNTY HEALTH DEPARTMENT {� -Mame: 4 ", 0311 fit t - Ig c/ k %'v d Environmental Health Section PROPERTY INFORMATION s.. P.O. Boz 848 Directions to property. (V C X/(— Mocksville, NC 27028 Subdivision Name: * `.,� _�C%� `' ��• �`j fr G i Phone #: 336-751-8760 Section: Lot: •r_... -" — AUTHORIZATION FOR �~ WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# 11 k � - �y AiJTHQRIZATION NO: A -ftp �a r me `�'n � zip. " 7c, **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 Forrn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. -� (In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ' / * *NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION" IS VALID FOR A PERIOD OF FIVE YEARS. !{° ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED M RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 3 # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE Q'!{�L� `TYPE WATER SUPPLY CO DESIGN WASTEWATER FLOW (GPD) 3 &0 NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE � x GAL. PUMP TANK GAL.. TRENCH WIDTH , ROCK DEPTH ./ LINEAR FT. 1 f� OTHER ("f ell REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT1 g' 1-c w.... i 5.. 5 , I c.r /, S (/ Ou we� V' 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 B.Xt.�_..N\ ` r. :) I' Qvi�u �� Glnv� �y�l2ca% AUTHORIZATION NO. `-"� �I VPERATION PERMIT **THE ISSUANCE OF THIS OPERATION PERMIT SHALL IND WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR PCiii) 02102 (RCVISCd) : ti �oczr < cu _ 20— F1 GIVEN PERIOD OF TIME. ::',vv. -W- 1s' Q&P�2 �y DATE: WQHAS BEEN INSTALLED IN COMPLIANCE MSN, BUT SHALL IN NO WAY BE TAKEN AS A 6 Z91 Reports Davie County, NC Tax Parcel Report Page 1 of 2 *WARNING: THIS IS NOT A SURVEY!* This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. Notes: Tuesday, 11/6/2007 Q poV Parcel Number: L700000011 PIN Number: 5766280431 ccount Number: IOFOOO19355630 Listed Owner #1: CURRENT DONNA LANKFORD Listed Owner #2: Mailing Address 1: 5568 NC HIGHWAY SOUTH Mailin Address 2: Cit : IMOCKSVILLE State: NC JZip Code: 127028 Legal Description: 0.484AC NC HWY 8 SOUTH crea e: 0.36000000 Deed Date: 11020010912 Deed Book and Pa e: 003860569 Plat Book: Plat Page: Buildin Value: 61420 Outbuilding andExtra Features Value: 12810 Land Value: IF9070 otal Market Value: 1183300 http://maps.co.davie.nc.usIGoMapslreportslreport.efin?CFID=2527&CFTOKEN=48631937 11/6/2007 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR). NAMEf co PHONE NUMBER 7G 7 ADDRESS ^� w © SUBDIVISION NAME, LOT # DIRECTIONS TO SITE ©� (.! DATE SYSTEM INSTALLED r y NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING _�►z� �.. 4/.0 74 DATE REQUESTED i l0 Q INFORMATION TAKEN'BY �U IJV co d "-S 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. 1ro3 - (GI n/1 u G16 6110 f 1✓ `( Au W 011J.- " / Parcel #: L700000011 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:L700000011 Account #:19355630 Owner Information uiidin : Tax Codes BXF• CURRENT DONNA LANKFORD nd• ADVLTAX - COUNTY T Market: 568 NC HIGHWAY 801 SOUTH eased• READVLTAX - FIRE TAX eferred• OCKSVILLE NC 27028 Property Information Township nd (Units/Type): 0.360 AC Vddress: JERUSALEM 5568 S NC HWY 801 Deed Information (— Local Zoning Date: 09/2001 Book: 00386 Page: 0569 Plat Book: Pa e: Legal Description PIN 484AC NC HWY 801 SOUTH 5766280431 Property Values uiidin : 66,62 01 BXF• 9,32 nd• 8,65 Market: 84,59 eased• 84,59 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00386 0569 09 2001 WD Unqualified Improved 0 i 00180 0027 04 1995 WD Qualified Improved 58,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic search Page 1 of 1 o11.V �0 ' v rz 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=1457735 8/30/2016