234 Walt Wilson RdDavie Countv. NC
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Tax ParrPl R Pnnrt
Tuesdav. October 11. 2016
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Parcel Information
Parcel Number: K5150A0003 Township: Jerusalem
NCPIN Number: 5747304488 Municipality:
Account Number. 82530254 Census Tract: 37059-807
Listed Owner 1: EPPOLITE ELAINE Voting Precinct: JERUSALEM
Mailing Address 1: 234 WALT WILSON RD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag. District:
Legal Description: 1.242 AC WALT WILSON RD Fire Response District:
Assessed Acreage: 1.18 Elementary School Zone:
Deed Date: 6/2008 Middle Schoot Zone:
Deed Book / Page: 007610001 Soil Types:
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Building Value:
Land Value:
Total Assessed Value:
°"�'�' Davie County,
�'o��,�� NC
33110.00 Outbuiiding � Extra
Freatures Value:
15690.00 Total Market Value:
48800.00
JERUSALEM
CORNATZER
WILLIAM ELLIS
Gn62,CeB2
DAVIE COUNTY
No
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48800.00
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�'l'�YJT�iORI�ATION NO. O 6 6% DAVIE COUNTY HEALTH DEPARTMENT ��� a M��''r
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j � ` Environmental Health Section PROPERTY INFORMATIO N .
Permittee's . P.O. Box 848
Name: � � -' � '�'�.;.0 �� `'r, Mocksville, NC 27028 Subdivision Name: '
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Phone #: 704-634-8760
Directions to property: 1.^a� .S `�-�� cm Section: Lot:
AUTHORIZATION FOR
(�: .;, l�l�,,s.�...�;�. �. ` �i,�� c, �,.�J ;��'.:y.�J ;`;a,,.�. WASTEWATER Tax Office PIN:# - ` -
SYSTEM CONSTRUCTION
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� �: Road Name��� �� ��. �.1� s�±� � Zip: .. �•.�
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Foim/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts. '
(In compliance with Article 11 of G.S. Chapter 130A, .yVastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
..�!` -;.._ C-�� r�.��. r�,, �.� �,.. ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
- ��:.�'�-� "�'� =� `�T�a::�-'�., ' F, IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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` '" '� * �=� � � � � , ,DAVIE COUNTY HEALTH DEPARTMENT
� � � ��' `� ' ,-IMPROVEMENT AND OPERATION PERMITS
Perm'ittee's t � _, .� . ,
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PROPERTY INFORMATION
Name: � '{ - �= �3' , t Subdivision Name:
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Directions to property: ' k�� �� ���� '^{��
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IlVIPROVEMENT
PERMIT ,
Section: Lot:
Tax Office PIN:#
Road Name �`' j . ,'° `Zip: t `
**NOTE** This Improvement Pernut DOES NOT authorize the construction or installatian of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained from this Department prior to the
constructio�nstallation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
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ENVIRONMENTAL HEALTfi SPECIALIST DATE ISSUED
***NOTICE*** TIIIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR TI� IlVTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE TI�S PERMIT BEFORE
INSTALLING TI� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYP • t�t�=-� # BEDROOMS � # BATHS �-� # OCCUPANTS j"� GARBAGE DISPOSAL: Yes or �No?
COMMERCIAL SPECIFICATION: FACILTTY TYPE # PEOPLE # PEOPLFISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE �'. �*x- �}r� TYPE WATER SUPPLY C o• DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE � i,
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SYSTEM SPECIFICATIONS: TANK SIZE n0O '� h, i
�GAL. PUMP TANK GAL. TRENCH WIDTH -� ROCK DEPTH LINEAR Ff.� v�
nTxrFu 1..� " �� t:-� .
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 INSTALLAT'ION. TELEPHONE # IS (704) 634-8760.
I OPERATION PERMIT
SYSTEM INSTALLED BY: rl- � �
AUTHORIZATION NO. � OPERATION PERMIT BY: � ��)�`JW�C. DATE: �`�_ /!
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAP'TER 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 OS/96 (Revised)
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' i �' �`. �� � �, � « , �� ,,ByAVIE COUNTY HEALTH DEPARTMENT � , ` � �'�")
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,� � IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's � •
Name: '� Subdivision Name:
Directions to property: � '`� - • Section: Lot:
IMPROVEMENT
: ti '.� �°- PERNIIT Tax Office PIN:#
_. .
Road Name: � �Zip: ` '
**NOTE** This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
, ***NOTTCE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
;;' PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER %
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYP f�1� �+ �t�=�� # BEDROOMS � # BATHS --- # OCCUPANTS i" GARBAGE DISPOSAL: Yes orNo �
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLF/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
�:_, �' ` ,
LOT SIZE ��� �`�"' �' TYPE WATER SUPPLY �:� • DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
'� � i!
SYSTEM SPECIFICATIONS: TANK SIZE G�`' GAL. PUMP TANK GAL. TRENCH WIDTH —� ROCK DEPTH � LINEAR FT. r�-1�-"�
• OTHER ��-- � C-' �3�(, ,
,
__REQUIRED SITE MODIFICATIONS/CONDITIONS: '
I IMPROVEMENT PERMIT LAYOUT
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**CONTACT A REPRESENTA'I'IVE 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: ,��.�. �--��`�. � ��
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AUTHORIZATION NO. `� C���7 OPERATION PERMIT BY: � \�`�`�`' `�' `��� V � � � � �
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DATE:
**THE ISSUANCE OF THIS OPERA , ON PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WTI'H ARTICLE 11 OF G.S. CHAP'I'E�d30A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEIvI yVj�L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OS/96 (Revised)
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n 1�' �,(Q � DAVI oUN ENVIRONMENTAL HEALTH SECTION
���a�'" " v � APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAM
ADDRESS
DIRECTIONS TO S
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PHONE NUMBER (O�1L�CI ��U�
SUBDIVISION NAME `
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DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER �' S o�Cl���'
TYPE FACILITY �� NUMBER BEDROOMS � NUMBER PEOPLE V D �
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING_„����G' � ,
�/'/1 .A�1 I /�n . � ,!/Ni �r, ,. �n n � 1 ..� , I I �1 � � _ `�/ l�
DATE REQUESTED.
This is to certify that the information provided is correct to the best of my knowledge, and that I understan�,i am responsible tor all charges incurred from this application.
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SIGNATURE OF OWNER OR AUTHORIZED AGENT �v��1t-
Rev. 1/93