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AUTHIRIZATI DAME COUNTY HEALTH DEP
Q A TMENT`..
# Environmental Health Section PROPERTY I
NFO ATION
APermtttee'S .t`� I :. .�, P O:Boz 848
Name � < Mocksville,'NC 27028. ,' Subdivision Name:
Phone# 336-751'-8760
Directions to property. 1„ 01'" Seaton: Lot:,
AUTHORIZATION FOR
WASTEWATER
Tax Office PIN:#
SYSTEM CONSTRUCTION2 ? .
Q� L ,. Road Name: NU)� � S' Zt
P
`**NOTE**This Authorization for Wastewater,System Constructton MUST.BE'ISSUED by theDavie County Environmental Health Section prior
to issuance of any;Building-Pemnits.This'Form/Authorizatign Number should be presented to the Davie County'Building Inspections'
Office when applyinfeforBuilding Permits.
(In compliance with Article I 1 G.S.Chapter 130A,Wastewater Systems Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
ONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVI HEALT $P AL T,:.` •DATE ISS EI ��
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE'!'AA'1'TM-fST�JM Df SCRIBED ABOVE RASSEEN INSTALLED IN COMPLIANCE ,
WITH ARTICLE 11 OF G.S. CHAPTER 130A; SECTION .1900 "SEWAGE TREATMENT, DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
wv g; +h$y%,*?,'.^y y&, rN°.a i` d '"ih►$ y.., ,� wq R, 1 X s ' , :Lr+:.a ra r�, .r.L."Y r�>s'i
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DAVIE COUNTY HEALTH DEPARTMENT /
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
jv*Permittee's �
! Name: 1,1. �' �• " ,-;'x��^�.. Subdivision Name:
,,.
,'`Directions to property: 1 ""` "t °` / Section: Lot:
' IMPROVEMENT
't.. x :,r:� , 3 :° , v ,, PERMIT Tax Office°PIN:#
{
Road Name: Zip: �- f } ;
**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 Department prior to the
st construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11,of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIROiL HEALTH SPF,eIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS " # BATHS I # OCCUPANTS 7 GARBAGE DISPOSAL: Yes q{ 0
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDLTMAL WASTE: Yes or No `
LOT SIZE TYPE WATER SUPPLY try 1= GL DESIGN WASTEWATER FLOW (GPD) NEW SITE _ REPAIR SITE
.r
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK _ g - 'GAL, TRENCH WIDTH,_ ROCK DEPTH ; 2 LINEAR FT. 2 J
OTHER I t~ {:- i ►J i t t irvi '
REQUIRED SITE MODIFICATIONS/CONDITIONS:`l_�;'
IMPRdVEMENTPERMIT LAYOUT *APPROVED EFFLUENT FILTER*-,* TF 6' � BELOWIFih1I5FiEii GRADE*z N p "al f-
r
icy �-0�r�
fti ..:moo Z10
'
tv
N /
**CONTACT A REPRESENTATIVE OF THE DAME COUNTY HEALTH DEPARTMENT FORTINAL 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 (704) 634-8760.
II xxxxxxxxx
OPERATION PERMIT
BY: 4,3 MC IJh�I
i T aV
Gyri.
PLC --TL.
lt-C.-T�p_j
(cl* , SoL, .f7
iV- .—
AUTHORIZATION NO. , A OPERATION PERMIT BY: T
PATE: "4U W
. L
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE S M D�SCRIIBEDOVE
EEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION.1900 "SEWAGE TREATMENT DTEMS",
BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05,96 (Revised) "
-Pi t9V-7> 10:190
R " DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME __C
• N• 3"SAIP"
PHONE NUMBER 39
ADDRESS
W-9*2- "L
Buis
SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE 4013-
�.i
Dv+� soynot>r�v
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER C. I/- Br�
TYPE FACILITY Vi'%;— NUMBER BEDROOMS Z NUMBER PEOPLE SERVED 2 -
TYPE WATER SUPPLY -A&� SPECIFY PROBLEM OCCURRING 1--vtt-s nat- d �•:+• :,, u.c1,(
DATE REQUESTED ' N "0o INFORMATION TAKEN BY
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 AGENTV e7' 114_/
Rev. 1/93
&w&-011-01122 2 U 13
Parcel #: L60000000605
Davie County, NC - Basic Estate Search
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Vievy Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
ParV #: L60000000605
Account #:82524164
Owner Information
Building:
Tax Codes
BXF:
BROGDON DORCAS ALEXANDER
Land:
ADVLTAX - COUNTY TA
Market:
652 NC HIGHWAY 801 SOUTH
sessed:
FIREADVLTAX -FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 2.050 AC
JERUSALEM
ddress: 6652 S NC HWY 801
Deed Information
Local Zoning
Date: 03/2003 Book: 00470 Page: 0056
lat Book: age:
Legal Description
PIN
2.189 AC HWY 801 LIFE ESTATE
5746957853
Property Values
Building:
85,5601
BXF:
7701
Land:
25,13
Market:
111 46
sessed:
111,46
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00470 0056 03 2003 WD Unqualified Vacant 0
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
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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/itsnettView.aspx?prid=1463566 8/24/2016