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755 NC Hwy 801 South Lot 5 Section 2DAVIE COUNTY HEALTH- DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE* OF COMPLETION *NOTE Issued irn_Compiiance"wifhiG,S. of North Carolina Chapter 130, Article 13c.r. Sewage Treatment and Disposal Rules (10 NCAC 1 -OA' .1934-,1968) Permit Nuffiber,: '/� 11 NameDate - — Location. i Subdivision :Name f- F x, w =4: ltd it Lot No: �__ Sec.' or Block No. �.. • <Lot 'Size '��'� € `Lf �r -.Mobile Home —___ Business _— Speculation House 7. �< No,' Bed� rooms _ No. Baths,' — No. in ,Family Garbage Disposal YES ❑ ° NO �, Specifications for System: /r ^ AutoDish Washer' -YES" 0 NO:'❑ 3 -Auto -Wash Machine YES N0 ;❑ t rs/+�+• }} 'Type -Water:=Supply *This permit Void:if sewage system described below is not installed within 36 months from date of issue: n , . . « ( , s }: tt it a. c�kyx �ry"k-.. is.. ,-.vw wa,.. ....r... -.•. .�, .. w•.. +.. . � �-..�.:.>,:....a�.--r...�..... - - A fi " a 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: or .1:00 1:30 P:M. on day of -completion., Telephone Number: 704=634-5985... - Final Installation Diagram. Systeme Installed by—� , y$ .t r , .b e , o Certificate of Completion L 1 fif�\vt Date., *>The signing of this certificate shall9 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. 4e" APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Z©' Davie County Health Department - Environmental Health Section l P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 74 Home Phone �� - & L 1. Permit Requested By E� N%LL Business Phone 2. Address PCL 2. 8 Z 76 1// 3. Property Owner if Different than Above AdrtrPSc 4. Permit To: a) Install Alter Repair b) Privy Conventional `Other Type Ground Absorption c) Sub-Division6-t.&---P UA Sec. Lot No. S� 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people 5PA— - 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 1% Bed Rooms 3 Bath Rooms Z Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals garbage disposal lavatory Z- showers Z washing machine dishwasher i sinks 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? Yes `�—No 9. a) Property Dimensions / 90 / '—�' � b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) ! t r 17a-a.P .� 4W Davie County. NC Tax Parcel Report Wednesday, January 11, 2017 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: ADVANCE WAK1V11VCT: 'l'nIb IN INUI A b U 1K V E Y Parcel Information E8070A0006 Township: Shady Grove 5871659712 Municipality: 82527425 Census Tract: 37059-803 BALEY MICHAEL D Voting Precinct: EAST SHADY GROVE 755 HWY 801 SOUTH Planning Jurisdiction: Davie County NC 27006-0000 LOT 5 GREENWOOD LAKES SECTION TWO 0.86 12/2006 006930892 0003 088 Zoning Class: DAVIE COUNTY R-20 Zoning Overlay: DAVIE COUNTY QD Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: Gn132,GnC2 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: All data is provided as is without warranty or guarantee of any Idnd either expressed or implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to NCor arising out of the use or Inability to use the GIS data provided by this website. i I t COUNTY HEALTH DEPARTMENT �D� S (Sepprovements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System-„G.S. Chapter 130-Article 13C) OWNER OR ,;.ON'iLRACTOR. r f 1_ .-i., %_. F i- DATE / i PERMIT LOCATION s . N9 1736- S.R. 736S.R. NO. SUBDIVISION NAME LOT NO. �� SECTION OR BLOCK NO. v� HOUSE [i' MOBILE HOME BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO 0' Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES © NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES [ NO ❑ SITE SUITABLE YES 13 NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: /_ r i.','l; 7 F�� WATER SUPPLY: Individual ❑ Publicl❑ IMPROVEMENTS PERMIT BY INSTALLED BY OF CERTIFICATE OF COMPLETION By Date.Q/, '� (8/16/73) *Construction must comply with all other applicable State and local reg .lations LOT AREA N oi ,G7iJ .-�7t 0�1 �_j`; Vw DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 Vie MOCKSVILLE, N. C. 27023 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NAME DATE ISSUED ADDRESS < / PERMIT N0. /7.%/ Explanation of charge .r AMOUNT DUE , % ' SANITARIAPI PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.