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123 Westview Ave.__ ; : _ > �� ,:. . . :s✓xo AUTxoRiz�,Tio1v 1vo: DAVIE COUNTY HEALTH DEPARTMENT ',' �' }� Environmental Health Section PROPERTY INFORMATION Permittee's ' ,K,... P.O. Box 84$ Name: � �' `�=� �' .�+-•� �- �- �--'� Mocksville, NC 27028 Subdivision Name: � Phone #: 704-634-8760 Directionstoproperty: �` r`� � Y�'' '-f�rti;�?1��G Section: Lot: f� � AUTHORIZATION FOR � � _ll �� , f�� 4 ~ � WASTEWATER _ _ f t�� ,'J '��r J� ` • }. � J SYSTEM CONSTRUCTION Tax Office PIN:# _. Road/Na�: K��`�V/�H✓� Zip:�o'Z �`'� **NOT'E** This Authorization for Wastewater System Construction MUST BE ISSLTED by the Davie County Environmental Health Section prior to issuance of any Building Pernvts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Bu' ding Pernuts. (In compliance with Article 11 of G.S. apter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION � IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRON E T L HEA PECIA ST DAT ISSU D , � . , ,, . , . : ._ j` i.�, � ... dry ,,.+ �•.' .. . .. ..., .. � . ., ,, , �._ . . . . �. . . -�.., , � , . �..�'`��y � .� / ... li ' P',iM i � , � \ :x ,� �. �' � N �� DAVIE COUNTY HEALTH DEPARTMENT � •` '' "'-`," -j � TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION , _ Permittee'�; � _ � NamP�: �' �-- �- ` ..� _,, _, a. �''� Subdivision Name: r- . �,., r Directions to property: ' f . ` ` �r '� <<� ��' �°�� Section: Lot: Il�IPROVEMENT 1�� •:� ' �.� �. !,� =�' � � r c_ � . ; . . PERMTf Tax Office PIN:# l �.� �' �, �'.<�� , ,� � Road Name: r''� �.-�`�/�F'l,��1��p: � � **NOT'E** This Improvement Pernut 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 frc�m this Departrnent prior to the construction/installation of a system or the issuance of a building pernut. (In compliance with Artjcle 11 of G.S; Chapter 130A, Wastewater Systems, Section .1900 Sewage Treahnent and Disposal Systems) ' /' � � / _.../.��Ci�/1:��._l� . ***NOTICE*** THLS PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THI.S PERMIT BEFORE INSTALLING TF� SYSTEM. RESIDENTIAL SPECIFICAT'ION: BUILDING TYPE Iu�`'�" # BEDROOMS # BATHS COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFf # OCCUPANTS �_ GARBAGE DISPOSAL: Yes or No # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE �_ SYSTEM SPECIFICATIONS: TANK SIZE �� h`� GAL. PUMP TANK GAL. TRENCH WIDTH �^ f> ROCK DEPTH �� /'LINEAR FT. �%'�� "� % �v I �--"' . a r REQUIRED STI'E MODIFICATIONS/CONDTI'IONS: �'��.C-° � I�.� C_: (- � k''�-:- r•:-'r 'i t � I^-S t�:.-=- I IMPROVEMENT PERMIT LAYOUT �4��-��T� Muy�ir.-, �nT �o,J c�r<. ti��::Fn�2. ��i��. t��.�� - T��,.( i,� � � � � iz , � �� i.�v`�� (` � � :, ��7"" ��l **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. I OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. �� OPERATION PERMIT BY: �«GI' DATE: U � L **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 OSN6 (Revised) ' :', "f ,o t�° r r , :�,��:.t» � r.-��' �,.g. �'�`rer t.IM' t , _ Permitfee s - Name: ., � � ��y.r�� ,.,`.._ ...�......_ .,- -� � �� '� .�� '��•F-vC% a � � � � DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION - {�- � � � Subdivision Name: Directions to property: -' �� ''�� Section: Lot: IMPROVEMENT ��' t' , : � 1 � ' �� ,;�, , � � � � PERMTT Tax Office PIN:# Road�Nam��e:��'�� 11�� : � rj�i% P� **NOTE** This Impmvement 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 conshuction/installation of a system or the issuance of a building pemut. (In compliance with Article 11 of G.S, Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) i ./ 1 / � �� / � l ***NOTICE*** THLS PERNIIT LS SUBJECT TO REVOCATION IF SITE ._..._.--- ' ,' I � ;� ✓, I " _ - ( "--"-- � �r� �! :i I t � PLANS OR TI-IE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRON�NT L HEA�."1'H SPECIALIST% DATE ISSUED SYSTEM CONTRACTOR 1VIiJST SEE TI-ILS PERIVIIT BEFORE -�� INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE I I�. �%� t: # BEDROOMS # BATHS # OCCUPANTS -� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFI' # 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. �= �' ' 1 " OTHER 1 REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 {►:.t� k ' � l� � t � �.i 'e.. , � +... 1_.'� * � (,, r �,,.5 �.. `^:'• IIMPROVEMENTPERMITLAYOUT ,,. � �-� ��a� �3- r.:��-; ,r , �,-, ,,:;�� : ;_�_r�:� ... �,:s��t. i'w:,�u�!=� "i u��.i+i,.:•C� .. -t 1 � �w�.o�++�w��..^.'.. / rF � .. F � �t , I �..�...� � e \ � � �' �./ 4� ��.,�� S„� �; �. ....'.� � **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 = 130 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. IOPERATION PERMIT � SYSTEM INSTALLED BY: - f�� 1 �C" r- - ,_� , AUTHORIZATION NO. I!l-� OPERATION PERMIT BY: _��'" DATE: �� a **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 OSN6 (Revised) � 'b. .. ` DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION • APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME �41' -S��u� PHONE NUMBER 7a� �y ��O ADDRESS /Z 3 l.��T�li%� S'�" I Pv �?/ SUBDIVISION NAME Co DI,C�rJ� �-�- 2 7 d/�% LOT # DIRECTIONS TO SITE Gol� %•� %��o4r�- - � � ��"`.. � �,".,�—�%Yf� J'�: DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY ��%�— NUMBER BEDROOMS � NUMBER PEOPLE SERVED � TYPE WATER SUPPLY C�"� SPECIFY PROBLEM OCCURRING �.+-u,, •:� �-" DATE REQUESTED �b�Z-3' G/% INFORMATION TAKEN BY �V�� This ia to certify that the information provided is cortect to the best of my knowledge, and that I understand I am responsi¢I�fo�l charges incurred from this spplication. SIGNATURE OF OWNER OR AUTHORIZED AGENT_ ' L��_.--_� I �—�--�---�'� Rev. 1/93 Parcel #: M4130A0021, Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search � View Pro�ertv Record for this Parcel View Ma� for this Parcei View Tax Bill Information Parcel #: M4130A0021 Account #: 70876500 Owner Information Tax Codes TEELE WILLIAM LESLIE & STEELE JOYCE A ADVLTAX - COUNTY TAX PO BOX 997 READVLTAX - FIRE TAX OOLEEMEE NC 27014 IOlADVLTAX - COOLEEMEE C W05FFEEFEE - SOLID WASTE Property Information Townshi Land (Units/Type): 1.000 LT JERUSALEM ddress: 116 WESNIEW AV Deed Information Local Zonin ate: 07/1986 Book: 00132 Page: 0501 Plat Book: Page: Le al Descri tion PIN .57 AC WESNIEW AV 5735753736 Pro ert Values Buildin : 30 71 BXF• Land: 10 00 Market: 40 71 ssessed• 40 71 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Prite 1 00132 0501 07 1986 WD ualified Im roved 29 500 View Pro�ertv Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 � kMl� . a. %,. �� U R� 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 inerchantability 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/itsnetlView.aspx?prid=1461468 10/11/2016