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-:AUTxoRiATION NO: 10 4S DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's P.O. Box 848
` Name: r Mocksville, NC.27028 Subdivision Name:
Phone #: 704-634-8760
Directions to property:,/1/ Section: Lot:.
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION : - -
Road Name: w 01�S Zi
p a rl
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County. Environmental Health Sectionprior
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)
EN IRONMEM
***NOTICE*..** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
~' IS VALID FOR A PERIOD OF FIVE YEARS.
HEALTH E0ALIST DATE ISSUED
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` ����' �,,..' "�' � DAVIE COUNTY"�IEALTH DEPARTMENT . M
�=��'� �`� , �.�-' "&� --- �"' IMPROVEI�IENT. AND OPERATION.PEItMITS PROPERTY INFORMATION
��' �,�erthittee'S ,�..' .:�,..,: � � `
•�� ;;�,���� �'t /`�f �s,���; ��"•�-� Subdivision Name:
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, I�uectIons�o property ' ,��%',� - Sect�on• Lot•
��""" �; ,�g� *� Il1�PROVEMENT � �
n �.,� � � � Il p
;, � �"�W .� ��`r'� ' PERMTi' . Tax Office PIN:# -
� �= � Road Name: � � �� Zip: � �g
, , , _ , . :.: - ,:
**NOT�** Thi§ Improvement Pernut DOES NOT auttiorize the constcuction or installation of a septic fanic system or any wastewater system. An '
Ai}THORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be'obtained from this Department prior to ttie
;. ' conshuc"tionTinstalla6on of a system:or the issuance of a building perr►u� '�'-, ' ' ` > i
(In compliance with�Article l l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �"
+'` .' '' = s ,� t,,.'i � ***NOTICE**+ THLS PERM�T IS SUBJECT TO REVOCATION IF SiTE'
� '" � .. �r �'�"'' ,,� �;.: ,r..�'��. � � 'lf ,` � ,�;'' 4 PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER <
,.�
,� �`. �';��`
' EN . IRONMENTAL HEALTH PECIALIST .� DATE ISSUED � SYSTEM CONTRACTOR MUST SEE.TEII.S PERMTI' BEFORE.. � �
, . :: ' INSTALLING TI� SYSTEM. _ .
:. < '; . ; ' -w,. , . ' '' '
R�SIDENTIAL SPECIFICATION: BUILDING TYPE �i _# BEDROOMS �? '# BATHS `'� # OCCUPANTS GARBAGE DISPOSAL: Yes or No
;.. , , .
COMMERCIAL SPECIFICAT'ION: FACII.ITY TYPE - # PEOPLE ' # PEOPLE/SHIFf # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ��C TYPE WATER SUPPLY �� DESIGN WASTEWATER FLOW (GPD) � NEW SITE ' REPAIR SITE �
, . ; / � , � .'
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK ' GAL. TRENCH WIDTH � ROCK DEPTH '� LINEAR Ff. •�� ,� d. '
� OTHER , .
.REQUIRED SITE MODIFICATIONS/CONDITIONS: _
�
� IMPROVEMENT PERMIT LAYOUT � � �
� � l' .
' � . � —� ' 5���; �,S' �.�k lrf ;r�� �
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**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FIlVAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30, - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION.,TELfiPHONE # IS (704) 634-8760.
-
OPERATION PERMTT
SYSTEM INSTALLED BY: 1 L
J� . .
�� .
,.. % •. :... , ...�.�'; ' �-:' .:.�, . � '�..�: ' '. , �.�;�. � .... ' ...:� ':�' , -_I;' .
�- ' �
AUTHORIZATION NO. �•� OPERATION PERMIT BY: . DATE: �' ,,.
**THE ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE ._,, '
WITH ARTICLE 11;OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMEI�IT AND DISPOSAL SYSTEMS' ; BUT SHALL'IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL EUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
�CHD OS/96 (Revised)
�
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-yam � �i a , ti., , ° •��'� C• f � i ✓
DAVIE COUNT- YI&ALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
. prmittee's� r
1Vame. fJ�`;mak �-'r Ja{'�r: p .rt'f" Subdivision Name:
Directions to piperty: Section: Lot:
IMPROVEMENT
f ; PERMIT Tax Office PIN:#
Road Name:
**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
constructionlinstallation of a system or the issuance of a building permit.
(In compliance witli Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
r r f` �:' ***NOTICE*** THIS PERMIT IS SUBJECPTO REVOCATION IF SITE
'.w PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM. `
RESIDENTIAL SPECIFICATION: BUILDING TYPE % # BEDROOMS 4* # BATHS # OCCUPANTS GARBAGE`DISPOSAL: Yes Jor No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT ` # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE fiG TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE -
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH c LINEAR FT. 0� t
OTHER i
s.
REQui& SITE MODIFICATIONS/CONDITIONS:
"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 (704) 634-8760.
OPERATION PERMIT /
SYSTEM INSTALLED BY: .✓ `-
,
1
AUTHORIZATION NO OPERATION PERMIT BY: DATE: `
--ice �
"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 05196 (Revised)
t
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME 0&,& le"
PHONE NUMBER
ADDRESS SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED'�S ��� INFORMATION TAKEN BY
cel #: J5160B0007
I
I ie County, NC
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J #:3516080007
Account #:34752000
Owner Information
Tax Codes
RIX & CORRIHER INC
ADVLTAX -COUNTY T
F.EADVLTAX
K G CORRIHER
- FIRE TAX
SVILLE NC 27028
Property Information
Township
Units/Type): 17.990 AC
MOCKSVILLE
:s: 1094 SALISBURY RD
Deed Information
Local Zoning
)8/2015 Book: 00998 Page: 0574
ok: 0001 Page: 091
Sales Information
PIN
5737976754
Page Month Year Instrument Qual/UnQual Improved Price
0249 09 1974 WD Unqualified Improved 0
0574 12 2014 TD Unqualified Improved 200,000
View Map for this Parcel View Tax Bill Information
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u have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120.
http://maps.daviecountync.gov/itsnetfView.aspx?prid=1189736 8/4/2016