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7853 Hwy 801SPeernuuee's-' DAVIE COUNTY HEALTH DEPARTMENTf� ' N nec t —714r4 Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: �� /�Iocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: �. AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 4 0 � A Road Name: Zip: **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) -'t r ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEAL H SPECIALIST DATE ISSUED ' 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 " SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �`' LINEAR FT. 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. r� AUTHORIZATION NO.M OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT HE SYS IBED ABO S BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 1 I 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) �� 75 NAME ADDR DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION AP PLICATION FOR IMPROVEMENT PERMIT (REPAIR) 2 kJe- PHONE NUMBER 3 ✓ �'Z� ���'�S�' 3 'f Gi S BDIVISION NAME C © O /'-P e. e-� It_, LOT # DIRECTIONS TO SITE Ir A- v . '�-Lc dLr+.-- �ff y.�r —Er" DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDE TYPE FACILITY NUMBER BEDROOMS 2--- NUMBER PEOPLE SERVED Z~ TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING rr DATE REQUESTED 2-414 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. 1/99 C /ltov DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sew ge Systems Permit Number Name Date . 7950 Location �•cr/ S`._ v v�D /+�% 1Lr Subdivision Name Lot No. Sec. or Block No. Lot Size,-- --_— House Home _ Business -- Industry No. Bedrooms o;V _.No. Baths ­,-.— No. in Family _ Public Assembly Other Garbage Disposal YES ❑ NO [ Specifications for System: Auto Dish Washer YES p NO 01 Auto Wash Ma^hine YES d NO ❑ :_ 1 �- Type Water Supply pc� cx� *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change - ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. ri 1 Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. `Final Installation Diagram: System Installed by — r 146 us� /Sv Q 5 Certificate of Completion Date P _ 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. Parcel #: N5010D0004 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Vieij Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: N5010D0004 Account #: 82531773 Owner Information Tax Codes 7411 CKNER ROGER PRESTON [M65 2,63 ADVLTAX - COUNTY TAX 20,79 SAIN ROAD 97,53 READVLTAX - FIRE TAX [301ADVLTAX-COOLEEMEECrn 97,53 KSVILLE NC 27028 W05FFEEFEE - SOLID WASTE Property Information Township nd (Units/Type): 1.500 AC JERUSALEM ddress: 7853 S NC HWY 801 Deed Information Local tonin ate: 04/2010 Book: 00824 Page: 0957 Plat Book: 0003 Page: 026 Le al Description PIN 1.50 AC HWY 801 ERWIN MILLS 5735936841 Propertv Values uildin : 7411 BXF: 2,63 nd: 20,79 arket: 97,53 ssessed: 97,53 Deferred: Sales Information No. Book Page Month Year Instrument Quai/UnQual Improved Price 1 00118 0497 01 1900 WD Unqualified Vacant 0 Z 00824 0957 04 2010 WD Qualified Improved 78,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information 1< Return to Basic Search Page 1 of 1 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/itsnetfView.aspx?prid=1464839 8/24/2016