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AUTHORIZATION . �
- ` Na �'� �`f .'� j� DAVIE COUNTY HEALTH DEPARTMENT
�L.C��c-tI � �`"� �� : , .
� ;, ,, ;Environmental Health Section . PK URMATION�
' �� Perniittee' � `' � "�; � � �' ,���. � � ' PA. Box 848 , � ' �� � � � �G ��C�G
= Name. " � �-� t`'k ' '�-��'�� � �' Mocksville;.NC 27028 , Subdivision Nam� �
.
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,
n'- ''= � � ': � '��'� �Phone # 336-751-$760, � � �':� ,
� Direcuons to property � � � `Ar'"!� "�`�' ' : �. . :` Section:
Lot
` , ` ' �-, . AUTHORIZATION FOR' . . ,
t �L-�>1,,,:�r1 l�. D � "'j eJC.� 't� o.J �SU r WASTEWATER � � " '
� SYSTF.M CONSTRLICTION "Tax �fftce PI1�I #
��T �'rJ; !'�.�..� ° Ro d N me:3-�+J'� '�v� �S Z�p: �.'i�Z�
**NOT'E** This Authorization for Wasfewater System Construction MUST $E ISSUED 6y the Davie County, Environinental Health Secdon pnor.
fo issuance of any Building Permits: This Fprni/Authorization Number should be presented to the Davie County Building Inspect�ons
� Office when applym for $uilding Permits." ` '' : � • ;
�.
(In eompl ance wit(i ' iele l�G.S, Chapter 130A; VVastewater Systems Section �:1900 Sewage Treatment aiid Disposa( Systems� �
5 ��
• :,r ,r , f ' ***NOTICE*** THIS :AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�` . 3� �:.ti.` ,(L "� .,.3 �a� IS VAI:ID FOR A PERIOIj OF FIVE .YEARS. �
ENV,� ,N _ E AL'HEALT SP CIA 1ST• ..' DATE SSUED � '• '� '
�. ` � � � t �
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4 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
emu'ttee's `-4 /G OG
C 1� t-•�° I t % Subdivision Nam
" �i Dirr-ectiod§ to property; (f t+1'� �°��({ y , Section: Lot:
IMPROVEMENT:
► i"7,`: t �?>° .t•_). 11�' 6 1 � PERMIT Tax Office PIN:#
t ....� 7
.� i 1 1�� RoadName:1 "-i`; `�Sr t Zip: '-7
**NOTE** 'Ibis Improvement Permit DOES. NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
an compliance with Article 11,6f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
-- ;
f ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENV ONMEN'I AL HEALTH SP "LIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE'
INSTALLING STEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE �S3 # BEDROOMS #BATHS S #OCCUPANTS GARBAGE DISPOSAL. Yes Or10)
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT S17A W 4- A"'TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �l? NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. ,TRENCH WIDTH 3Cc� ROCK DEPTH. LINEAR FT.
OTHER 3 �1-STefit�e.�77�1I�'s.� _ 1.�51L11.L 'L11?.S �ti>.C. N1�:
REQUIRED SITE MODIFICATIONS/CONDITIONS: I ^TSTA► t,1 C -o � ,T0L*, . Y - C- e , O C (' Bli i �- ice. l,J G
IMPROVEMENT PERMIT LAYOU� *RPPRQVED EFFLII FILTER* *RISER(S): IF:6' 1 BELOW FINISHED GRADE*
1 c,M P%
DCRD 05/96 (Revised)
.�{ .•S µ �11 a��.'<_s� � ".1� w `'� :�'�'` X �, a:.: .-� '��-r3'"t �� .,� � ' y ,�'�' /t, �,;`u`" f�''s ft,y �;@
•let
•DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
erni{ttee's
I � •
Subdivision Nam
"mDjrections to property: t } ! <''+ �',` t`, r.,. Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
?
Road Name: ► _. m , t Zip: {,w
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Depirhnent prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 1130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
PLANSR THE INTENDED USE ERMIT IS SUBJECT
ANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TILS PERMIT BEFORE
INSTALLING T�,P STEM.
r t1C l /00
RESIDENTIAL SPECIFICATION: BUILDING TYPE 3 # BEDROOMS BATHS %• ,.'S # OCCUPANTS GARBAGE DISPOSAL: Yeso No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL' WASTE: Yes or No
LOT SIZ LO -t TYPE WATER SUPPLY t -1-L- DESIGN WASTEWATER FLOW (GPD) D NEW SITE REPAIR SITE #
/oa IZ,�,f 1= i
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -3ln ROCK DEPTH LINEAR Fr. — -
OTHER Z m C:.iG�c c,�3 ru C;.. I-A511A LL L r.j �S 7 t C7. C . tNm ►J.
REQUIRED SITE MODIFICATIONS/CONDITIONS: K)S j A t, L t ' C..0 tO -vc%)�L i C•/' ;—'' D fw F TAI t► D 1^) C-,
L
ROVEMENT PERMIT LAYOt APPROVED EFFLJEIAT FILTER* *RISER(S) I1= 6" . BELOW FIHISHED GRADE*
lei -
C— C- a
eiGrin..J+C.-a `(o h1 FA7t1
r k" �r�� R�1t 1..1',V ••1 ^�i VSS, Icy 2�G.w�.�
F7L
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHi
,W
OPERATION PERMIT
s
G
Gr
() P
�J
SYSTEM INSTALESD BY:
TON OF THIS SYSTEM
6ucxxxxx
� D
h
OPERATION PERMIT BY /
AUTHORIZATION NO. �Qa;�i/� DATE:
1 L-) A
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE STEM 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 05N6 (Revised)
J,
i
,
2:-.)o
C
ADDR
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER q j r- 8'791
IVISION NAME
LOT #
DIRECTIONS TO SITE jU e6 am S - a - 4 Fi- - 1 a -t 1q4%
DATE SYSTEM INSTALLED 6'0"-S NAME SYSTEM INSTALLED UNDER Rtnry CAa 44S
TYPE FACILITY 8041A, NUMBER BEDROOMS NUMBER PEOPLE SERVED Z
TYPE WATER SUPPLY ILLU/ SPECIFY PROBLEM OCCURRING �p rarnL &WO ,So�ioo.r�i•�
1 Sao s4o. '• - W:Lt h u.O n c,W T- K_ a 1&* T. off,
DATE REQUESTED t U' INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand 1 am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT C'
Rev. 1/93
f l� 99�o,�H to X3 �� le l u `/3 y7
Parcel #: L600000041
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 #:L600000041
Account #: 19180000
Owner Information
Building:
I Tax Codes
BXF:
ROTTS HENRY T8, CROTTS KATHERINE T
Land:
ADVLTAX -COUNTY T
Market:
164 GUMBERRY LANE
assessed:
READVLTAX - FIRE TAX
[Deferred:
OCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 107.970 AC
JERUSALEM
ddress: 5987 S NC HWY 801
Deed Information
Local Zoning
ate: 07/1953 Book: 00052 Page: 0320
[Plat Book: Page:
Legal Description
PIN
122.379 AC HWY 801
5756732172
Property Values
Building:
142,9201
BXF:
5,2001
Land:
571,27
Market:
719 39
assessed:
232,43
[Deferred:
486,96
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00052 0320 07 1953 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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000r,01_111:
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/itsneWiew.aspx?prid=1478158 8/24/2016