116 R Shore Dr Permittee'sPAVIE COUNTY HEALTH DEPARTMENT
,1Ia#j, dC✓ r/ �/�7"f-(n Environmental Health Section PROPERTY INFORMATION
\ � ��,� f, P.O. Box 848
Directions to property: 1-' Mocksville,NC 27028 Subdivision Name:
biji
Phone#: 336-751=8760
Section: Lot: '
AUTHORIZATION FOR
WASTEWATER Tax Of ice�P`1 :#
SYSTEM CONSTRUCTION ax -
AUTHORIZATION NO: 002701 A 'Road Name /
ZIp2"O �(
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
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
COMMERCIAL SPECIFICATION: FACILITY TYPE / #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY _/ / DESIGN WASTEWATER FLOW(GPD)S� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 15 h ROCK DEPTH LINEAR FT
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: '
IMPROVEMENT PERMIT LAYOUT
i
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: 5�)��� �l)�J►J
QIPtorLASTbGl4A-6 Z
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AUTHORIZATION NO. I- OPERATION PERMIT BY: DATE: j j
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS M DESCRIBED AB 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 SATISrFAyyC�TORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102(Revised) l /� L. �/✓ 1 � �'r• �t
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)/I
4NI,
NAME [ Y 1 PHONE NUMBER
ADDRESS_ Z/ 6���& hr. //! / Z7OZ�
e i10C14S�i�lQ N SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
ud me j N l
DATE SYSTEM IN,'STALLEDNAME SYSTEM INSTALLED UNDER
sidN
TYPE FACILITYff NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY—JAL I I SPECIFY PROBLEM OCCURRINGgil !i JI✓ Nd�
t ldc,A) 4 /c
DATE REQUESTED INFORMATION TAKEN BY lit
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.1193
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Permittees �- /�� ' ,., . AVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
,J' , P.O. Box 848
Directions to property:! '`' '` "'" ' Mocksville,NC 27028 Subdivision Name: Abin boe
Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
NIP
�ce�I : O /P ,1
AUTHORIZATION NO: 002701 A Road Name: �/z Zip:2w2S
**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 FornVAuthorization 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)
J ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE_ #BEDROOMS #BATHS—,2_—#OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT / #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY r/l DESIGN WASTEWATER FLOW(GPD), Ey NEW SITE REPAIR SITE r
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH,_ LINEAR FT,�.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT i
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:
o T-
t�
cr�4r�s
f
AUTHORIZATION NO. J.AOPERATION PERMIT BY: DATE: 'f1C0
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED AB 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)
i.....GRADY L TUTTEROW regoing certificate.................................... .....
EPARTMENT OF TRANSPORTATIO FINAL SUBDIVISION PLAT APPROVAL -� -•••-•••••----•••-••-••-•••--•-•-----••-•••-•••-••••certify that this plat was down ......................................HERE GIVE NAM
'North Carolina...................... ............................M.
under m supervision it m n
County
DIVISION OF HIGHWAYS yo a actual survey made under my supervision(deed descriion Filed for registration at............................o'clock..............
This is to certify that this plat meets the recording requirements of the Subdivi- recorded in Book.................... .•Page..._.........,etc. oiler; I,a Nota Public a Countyand State aforesaid,certi at A ....••.1' A'L..."•'-'"' ''""""""'•"••�F C """
P OSED SUB0IVISION D sion Regulations for MOCKSVILLE/DAME County and,if applicable,that a earl'"indi"""""'"""""""""' ' 9 ) ( ) Notary AND ICTAL TITLE OF THE OFFICE NTNG
- that the boundaries not surveyed are clearly indicated as drawn from information fourtf in .._....... ............................ ...........,aRegisteredLand ...................................................
.............19._..................... and recorded in
CONSTRUCTIO TANDARD ERTIFICATION certificate of approval has been issued by the Division of Highways pursuant to . .......................... ...........................is certified
Article 7,Chapter 136 of the General Statutes,State of North Carolina Book.................................................Page.........................;that the ratio of precisioi as Surveyor, personally appeare fore m s day and acknowledged the THE CER ATE P D UPON)
calculated is 1:................................; that this plat was prepared in accordance with C.S. execution of the foregoing instrume ness my hand and official stamp or to be correct
Plat Book........................................—Page...._.. ...............
APPROVED.................... fi4l....... ....................................... 47-30 as amended.Witness m original signature,re"n n numb r and seal this rth seal,this......_.........--..... ......da of...... ........119...............-.
ISTRICT E EER This the......................Nay of................... Y 9 9 ...... y .....-• This................ da of .....19.........................
9
HENRY SHORE, Register of Deeds
JANUA 8
......... day of.............�............................A.D.,19 .--•--.. ---.... Probate fee 50¢paid. �
DATE....... ............................................................... ............:. l Notary lie L.E.Speas,Register of Deeds Filing Fee$ Paid
.............................. r
TH CAROLINA-FORSYTH COUNTY DIRECTOR OF PLANNING (Seal or Stamp) Registrw n umber' S r Stamp My commission expires .................... DEPUTY-ASSISTANT DEPUTY-ASSISTANT
CAROC%,,,
- : z: SEAQ a = I
L-2527 Q S; i i
o•
C.yNp SURv .(���.� cwswoMoN r
J - - - - •ice 'I 4NN••• G\0��` - - - - - - - SI+V • _
"'••qt r L. TU% `•o` Ns SCAA W
- - ''�•r.n n n s NSP ltLi00/�1ft[a-
` VIClN{TY MAP
we. hereby certify.that we are the owrwo of
the property shown and described hereon and
ROi/h w� our free consent. establish minimum we h*reby adopt this " of weet-
✓!Y1 C .` on
`?I�<� L back lines and dedicate all streets. alleys. walks.
P, I porks and other sites and eawn»nts to Public
O DER
-or prFvWe We as noto4, Futheirnore. we hereby
X0.26 ` ��'( , dedicate any and all sOr nary sewer. storm sewer -
2 6 31 f ` fj ` -- and water lines to Davie County(d appRcable)-
69.26 OWNER
OWNER
31 t
C3* J0
°u _ ��CI >
Z g ��P Q 00 S 69•� J,�. ' �O/ Depor1. tm nt hos evaluated the subthat the Davis division
hh
0 re P. R'S RUN
4 00 f K:-, h led kriteria and oonddione estobtished 1. hereby certify that the subdivision plat shown
laJ _ -�- respect hereon has bean found to comply with the Davie
19 C Subdivision Regulations withexception of
taJ ti� q? _ e $ \ by stag- low or pramu atad thereunder and the -
z G ^ 68'3> sane Is found to comply with sutA criteria and
D1y dances, M any. � are naiad in tM
.�• '9 4 0► I s3• conditions CXCEPT as set forth In such evaluation. �.
'` 1� rL V1. �e 0j f _ ''p �� For details of this evaluation and for limitations. approve of the Pbnng Booed and it has been
_ - - approved for reCOrarn9 (r1 the QKKe Of DMds. _
r� tr e+e the written sport on file at sold depo►tmenR R is herby noted that such approval for
_ C► racordatlon does not include oppmM for the
_ IMPORTANT -NOTICE_ THIS CERT1Fi ATE DOES NOT conKructian a occupancy of buildings or tttructurss_
CONSTiT= A PERMIT OR APPROVAL OF INDIVIDUAL
�� - �• PG rr°� r�.�- W T�,� LOTS IN SAID SUBOMSNON FOR MTALLATION OF
A' t _ SEWAGE FAC&ITIES
�5 C i�,_ DIRECTOR
t DAVIE COUNTY PLANNING DEPARTMENT
Z to cl
DATE DAVIE COUNTY HEALTH OFFICER
moo" �cC.r o� ti 't �� d'
lit tT ��h 1$q * _ ? 43• Ah CERTIFICATE OF APPROVAL 8Y DAVIE CO. COMISSIONERS_ CERTIFICATE OF APPROVAL BY THE PLANNING BOARD
�-°- 11 COhT 69•s� s ►.o
C R C 3• 0444,01
f i. ,Jae t.opg cnai,.+tan rn. Davie County Pbnptng Board !►os hereby
pG d ORN O 0 � �� o R,44 of the Davie County Board of Comissionens hereby approved tfe final plat for the Subdivision _
YO £R P ti Q%f certify that said board has approved this plat entitled ROOSTER'S RUN
entitled . ROOSTER'S RUN
m 1 t O.B j DACHF on this the day of .199x.
Z tD Q H 69.20 01 _ ` 8 /J R y DATE CHAIRMAN ?.
DAVIE COUNTY PLANNING BOARD
0 °3• 9. Sias �R/�. CHAIN". DAVIE COUNTY BOARD OF COMISSIONERs
S
3 Ny REVIEW OFFICERS CERTtF1Cl►TE
C 1. John Ga�mors. Review officer of Davis County. THIS SURVEY CREATES A SUBDMSiON OF-LAND WITHIN .
�OA,7, certify that the mop or plat to which this certification THE AREA A COU OR YUNUIPALi1Y THAT WS
_ ,,)v R ` s affmW trusts all statutory requirements for recordwq. AN O THAT PARCELS OF LAND.
- m -
c
b r ` REVIEW OFFICER DATE GRADY L R.LS. L-2527
LOT #5
AREA 3.484 ACRE
Q^� ROOSTER S RUN
fti 4 ' - - - - - - -
Crj OWNER -�-- _�---•-y--- -DEVELOPER
r k a M1CNAEL 'h` JAMES
W �► 1602 US HWY. 601 30U?H
MOCKSYILLC N.C- 27016
U (104) 264-4481
Ii C74. tAX MAP (1E1't 9-5. d poHidn it PARCEL S1
_- � - ANUSALEM TOWNSHIP
n W"" ltdk• f"Vnd t
_ .•�N �"�. 0 Irpn a.,►e ..l DAVIE COUNTYN NORN CAROLINA
JANUARY 16, 190M
b(�q _ p.cfr — rail �blVI IQ PYI _
_ �y 0.8.+7 �� K, Jq ME 'skis �. ,� tUTI `110 W �71JhV YhVG t'A)UP ANS
Pg. — 137 LJd Wrf Gtit)Fi H ROAD
1 - 7�� _ (vtyl Atoa p p04 e.:f.. M(jCkWLl_E. NC - 779;10
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1" purfEi end ag6 tx7)GiHutj I-V-001lot sitist le, I 111111 t
,�. ,k,f,e4 1118 t LT AL1 6 80 I6G 240
All
**ter tw Ge •wpplied @y Dilute County tYuler 00 it- -
All naw servise utilities OW 1>s us4wilrommi
SCALE IN FEET- ewwtns i>ltsrllEl =
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