6858 Hwy 801S1� • ''� ® c' r'� ;, � <;:�;::a. r * r'` as ���, t.:a, .:,,e�fy: f,,4 .. � e i
Permittee'.5,, DAVIE COUNTY HEALTH DEPARTMENT
Name: L A UJ, Ct V%N Environmental Health Section PROPERTY INFORMATION
J/ P.O. Box 848
Directions to property: C t Mocksville, NC 27028 Subdivision Name:
lcf %,r Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
Q C Y 0-. -5 l l 0 AM �Cr `�C� ��r C�/ WASTEWATER M 7 3j -073).
SYSTEM CONSTRUCTION Ta Qf ce PIN:#
AUTHORIZATION NO: 002856 oadName :'a ( Zip: 6`a
**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 Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pen -nits.
(Incompliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems)
yd�J �j ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
U ter/ .' 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
COMMERCIIA�L SPECIFICATION: FACILITY TYPEr # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE l ' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) aLl G NEW SITE REPAIR SITE
t� /HaX z
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3- ROCK DEPTH 3 G LINEAR FT. F O
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUTS
MIA 1 `
1 � I
N.
to 6,01:5
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:
d
y S4
l
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
aory
**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 02102 (Revised) C�' V v / v • J11 & qW
37°✓^ a • s � �.;. �:. +I,': tJ r,,:i '.:;w{ �t r^''%y tw.sq':a+wY-0 � "' }e:., •`�°+"* .n..�.�:.�:�,4.-�.��,•, .v •:+,,,,d:r 1 "'-•-. .�,,;',i�,..•. it`
`PerrNag.
4 1 DAVIE COUNTY HEALTH DEPARTMENT
±
Na�iie:. (- r� ls'l.� , i k � CI kN �� Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
'9 Directions to property: Mocksville, NC 27028 Subdivision Name:
f 1i Phone #: 336-751-8760 r
Section: Lot:
AUTHORIZATION FOR
( G. rl t t'f�e e, 1,r. � � j WASTEWATER 7"1 fG_ 7 � _ 7 3
SYSTEM CONSTRUCTION
Tax ffice PIN:#
AUTHORIZATION NO: 0028156 A Road Name: Zip: j(- .
**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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
"'.,._ ��`'` G✓ . IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE E # BEDROOMS �_ # BATHS
�2 # OCCUPANTS GARBAGE DISPOSAL: Yes or No
N 5}
F -
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY �_ DESIGN WASTEWATER FLOW (GPD) al% G NEW SITE /REPAIR SITE &---
� TUU
SYSTEM SPECIFICATIONS: TANK SIZE _GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DE I.1 3 G LINEAR FT. v
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
ou5� Eco
N
r
j
�- •gar s
d,,, /r
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.
SYSTEM INSTALLED BY: (i] i to �h
r
I
f
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: _ v
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
DCHo(>uV,3ed) A('c�'67
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
ADDRESS &95� Ne MAI� 0/ s/�1���s���f Q SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
04,
ViN w4b9 1
3a 6 4�Z' v�
7
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY Se - NUMBER BEDROOMS 41 NUMBER PEOPLE SERVED
n
TYPE WATER SUPPLY C"a `y"l'G . SPECIFY PROBLEM OCCURRING l/NGS &6Z /�,��
DATE REQUESTED si 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 AGENT
Rev. ,/93
• MAp Frame
o sse�t'
Q° v
Page 1 of 1
Davie County, NC - GIS/Mapping System
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http://maps.co.davie.nc.us/GoMaps/map/mapframe.cfm?CFID=17813&CFTOKEN=497368... 4/9/2008
Parcel #: L500000050
Davie County, NC - Basic Estate Search
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Parcel #: L500000050
Account #: 82530898
Owner Information
BXF:
Tax Codes
nd:
LLIAMS BRIAN R
L858
arket:
ADVLTAX - COUNTY TA
A
ssessed:
NC HWY 801S
eferred•
FIREADVLTAX - FIRE TAX
CKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 6.120 AC
JERUSALEM
ddress: 6858 S NC HWY 801
Deed Information
Local Zoning
Pate: 06/2009 Book: 00796 Page: 0295
Plat Book: 0003 Page: 103
Legal Description
PIN
5.30 AC HWY 801 LOT 1 PHELPS
5746738732
Property Values
uildin :
ELM
BXF:
3,07
nd:
46,28
arket:
107,10
ssessed:
107 10
eferred•
Sales Information
Vo. Book Page Month Year Instrument Qual/UnQual Improved Price
00796 0295 06 2009 WD Unqualified Improved 0
00155 0556 08 1990 WD Qualified Improved 50,500
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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� u ltI
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=1467844 8/31/2016