6943 Hwy 801S (2)4�jxk ;-nr'iS�n'v�*'` 'r..4+ F°ry.,^i;`IS�:e,ti: ^��a-�'1;'z.� ,�i;,`���,��;� ,._ � „„ . f �;: � ° �a 'y"'w:" '°f:Y. ,yl�,?'� ,�`i*�'£.,,, ,:
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AUTHORiz�TioN No: '� �j ��j DAVIE C UNTY HEALTH DEPARTMENT . ,:
� � � ''�'k� � .'� �nvironmental Health Section PROPERTY INFORMATION .
perm�ttee's � / P.O. Box 848 : � � � '
� �Name.• ���,� !�^..S Mocksville; NC 27028 � ", Subdivision Name:: -
, ` ` � � ,[/�' �/l,l� /J /�Phone # 336-751-8760
: Directions to property: �fl�� Section. Lot:
+ " � / AUTHORIZATION FOR '
��G, ; WASTEWATER ;
''�".._S��r, /�� ; Tax 0 fi I :# _ , _
SYSTEM CONSTRUCTIOH . .
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� �rn q
•' Road Name: C�L/ � Zip: �� a
**NOTE** This Authorization for Wastewater System Consuuction MUST BE ISSCJED by the Davie Counry Environmental Health Section prior
� to issuance of any Building-RermiGe. This Form/Authorization Number should be presented to the Davie County Building Inspections ,' '
Office when applying for Building Permits. :
. .,, .,; . .
(ln 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'� .��� �/ -�G�` �".� "��` ' IS VALID FOR A PERIOD OF FNE YEARS.
. ENVIRONMENTAL HEALTH SPECIALIST,. DATE ISSU6D
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'�" TM ,.TMPROVjEMENT AND.OPERATION PERMITS ` PROPERTY INFORMATION
'� �er[pltt�e=s � � � �� `� r' � � ��
: �Name � �""'� ��, � ..5� ' i ' Subdrvision Name:
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� Dire,��Uoa�'fc�� property �^ �'��*� ��f`t� ��' �c°.��� Sect�on Lot .
�, � ,�, . 1 � IMPROVEMENT ,, ,, ;
� ,� �'t!` ,. ;,.� � �; _ ��,�"^ PERMIT � Tax Office P N # `
, �� ` � t� ��� �,,� r,... ,: �
� ' �Road Name. �t� - : Zip '�,� t. L:���y �
_ ; . , provemeri , ; , _ � ; , . . . , , .
t .
**NOTE** This Im t Permit DOES NOT authorize the construction or"iristallation of a septic tank system or any,wastewater system An,.�
.-".; ALTTHOWZATION FOR WASTEWATER SYSTEM CONSTRUCITON.must be obtained fr�m this Department prior to the '``- �� �'
' , - conshuction/'u►stallation of a system or the issuance of a buildi�ig pemut. �. ° � ' � ' ` ' � `,
, „ ;: • . .
;(In comphance�with �lrticle l l of G.S.� Chapter 130A; Wastewafer Systems, Section .1900 Sewage Treatment and Disposal Systems)
,•'�'' ,� r;; -' � .x. ` ' ' `: ' ***NOTICE*** TI-QS PERNIlT IS SUBJECT, TO REVOCATION IF SITE
,r::' ,�3 d.s".. � � _,.,, � '`�`'-'�' �,�"' >, � ,,,; �'' . � PLANS OR THE INT�NDED USE CHANGE. YOUR WASTEWAI'ER -
�` �' ENVIRONMENTAL HEALTH SPECIALIST;.`. � DATE ISSUED SYSTEM CONTRACTOR MUST SEE TI�IIS PERNIIT BEFORE �
INSTALLING,THE SYSTEM.
- : ,:
�� RFSIDENI7AL SPECIFICATION: BUILDING,TYPE ^� # BEDROOMS �# BATHS �_ # OCCUPANTS, �GARBAGE DISPOSAL: Yes or No
�� ", COMMERCIAL SPECIF7CATION: FACILTfY;TYPE " # PEOPLE # PEOPLE/SHIFT # SEATS � INDUSTRIAL WASTE: Yes ot No
' WT SIZE' TYPE WATER SUPPLY� � ' DESIGN WASTEWATER FLOW (GPD) � NEW SITE ,' ' ' REPAIR SITE ''�""'�
�
. SYSTEM $PECIFICATIONS: TANK SIZE GAL PUMP TANK + GAL. TRENCH WIDTH �G • ROCK DEPTH �� LINEAR Ff�l�f� .�
;, _ , , , ...
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�OTHER �' �� � � ,
REQUIRED SITE MODIFICATtONS/CONDITIONS: : - `:` ' � '' ' � i ' ' � .
IMPROVEMENTPERMTfLAYOUT�
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CONTACT A REPRESENTATIVE OF THE DAVI� COUNTY HEALTH DEPARTM �
�.
, - , , . ,
'. ` ** ENT,FOR FINAL INSPEC'fION OF THIS SYSTEM "
' �". -, ':' : BETWEEN 8:30 - 9:30 A.M. OR 1 00 = 1:30 P:M. ON THEDAY OF INSTALLATION: TELEPHONE # IS (336)751-8760. �
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OPERATION PERMIT ` , . ��. �ti J � ;
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SYSTEM INSTALLED BY: ` C�/ f
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� AUTHORIZATIONNO. OPERATIONPERMTfBY: ,� DATE: � �� ��� `�
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'*•TE� ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT THE SXSTEM DESCRIBED ABOVE ►iAS BEEN INSTALLED W COMPLIANCE .;;
, ,
- WTfH AR'fJCLE,11 OF G.S.;CHAPTER 130A, SECTION :1900 "SEWAGE TREATMENT AND DISPOSAL 3YSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A •, :
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY G�VBN PERIOD OF TIIvIE. = ' ' ;
`DCHD OS/96 (Revised)
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1686
DAVIEC LINTY HEALTH DEPARTMENT
tr, IMPRO EMENT AND OPERATION PERMITS PROPERTY INFORMATION
Subdivision Name:
r
Dirg�Ion�'i�(i`property:1 ✓4 Section: Lot:
IMPROVEMENT
PERMIT
Tax Office pIN:#
lr Road Name: Zip:
` **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
construction/mstallation of a system or the issuance of a building permit.
i.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** TIES PERMIT IS SUBJECT TO REVOCATION IF SITE
14 ! ✓ F •`'` „'' , .r PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE_ # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY? DESIGN WASTEWATER FLOW (GPD NEW SITE REPAIR SITE �" r
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TI;ENCH WIDTH - C ROCK DEPTH S LINEAR FTQ*
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: d /-Y
**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 05/96 (Revised)
r,
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
/ WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAM( l• S PHONE NUMBER
'ADDRESS W lO •<`� SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN BY
q�`99 -,�H oaf 9 000
Davie County, NC
Tax Parcel Report
A 7060.
47056
p
7000
;181 47010 ,,
`6995`
4197
70
` 47044 x.
7045 *.
L212 P01 7067 .*7059
X7114 7093 47081 \ i�:25\ 7021 \
,� E �122,
i121 7>�
*7111 —
Parcel Number: L500000047
NCPIN Number: 5746827844
Account Number: 24076000
Listed Owner 1: ELLIS FRED O
Mailing Address 1: PO BOX 1018
City: COOLEEMEE
State: NC
Zip Code: 27014-1018
Legal Description: 49.820 AC HWY 801
Assessed Acreage: 49.24
Deed Date: 1/1982
Deed Book / Page: 1982E0071
Plat Book:
Plat Page:
Building Value: 181420.00
Outbuilding & Extra 4030.00
Freatures Value:
Land Value: 308280.00
Total Market Value: 493730.00
Total Assessed Value: 221680.00
o
Davie County, NC
O U NS
Thursday, August 25, 2016
WARNING: THIS IS NOT A SURVEY
Parcel Information
Township:
Municipality:
Census Tract:
Voting Precinct:
Planning Jurisdiction:
Zoning Class:
Zoning Overlay:
Voluntary Ag. District:
Fire Response District:
Elementary School Zone:
Middle School Zone:
Soil Types:
Flood Zone:
Watershed Overlay:
Jerusalem
37059-807
JERUSALEM
Davie County
DAVIE COUNTY R-A,R-20
DAVIE COUNTY CZOD
No
JERUSALEM
COOLEEMEE
SOUTH DAVIE
PaD, GnB2, PcB2, PcC2, GaD, CeB2, MsD
X
WS -IV -P
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