1859 Cornatzer Rd�i• Y`C 1) _ t i' •� -i �; ' •i ;. +, f 3, ' a.y iii 2,.,{-nse^'✓*.} S:'"'Y w Ia ,.y,k s a x; _ rel r dr,.aw3-
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AUTHORIZA"I ION NO: DAVIE C LINTY HEALTH DEPARTMENT
nvironmental Health Section PROPERTY INFORMATION
Permittee't P.O, Box 848
Name: !/t//�l�te. Mocksyille, NC 27028 Subdivision Name:
Phone # 336-751-8760
Directions to property Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office 'PIN:# -
SYSTEM CONSTRUCTION fq -
Road Name: a G a 7oa8
**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 Form/Authorization Number should bepresented 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)
/ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
iz
IS VALID FOR A PERIOD OF FIVE YEARS..
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
Davie County, NC Tax Parcel Report 169 � Tuesday, September 27, 2016
C\1
;6729.
949' 1679
985 254
4652 i,t 9
X49 / J j, j `
'1847
�$) i `\
2309 _ ,�o�P f' - _ 939.3. �N
Outbuilding & Extra
1000.00
WARNING: THIS IS NOT A SURVEY
,.
�_ ,
Pafcetlhfonn�i�on
138180.00
Parcel Number:
G700000042
Township:
Shady Grove
NCPIN Number:
5769584652
Municipality:
Account Number.
65764000
Census Tract:
37059-803
Listed Owner 1:
SHORE JAMES ODELL
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
1859 CORNATZER ROAD
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-A,R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-7142
Voluntary Ag. District,
No
Legal Description:
2.700 AC CORNATZER RD LIFE
Fire Response District:
CORNATZER - DULIN
ESTATE
Assessed Acreage:
2.43
Elementary School Zone:
CORNATZER
Deed Date:
11/2005
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
006330216
Soil Types:
PcB2,RnD
Plat Book:
0004
Flood Zone:
x
Plat Page:
160
Watershed Overlay:
-
Building Value:
98430.00
Outbuilding & Extra
1000.00
Freatures Value:
Land Value:
38750.00
Total Market Value:
138180.00
Total Assessed Value:
138180.00
1:0::
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie County, NCimplied 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 or arising out of the use or inability to use the GIS data provided by this website.
OPERATION PERMIT
SYSTEM INSTALLED BY:
OPERATION PERMIT IT lY;AUTHORIZATION NO. K v
DATE:
r r _
.ry ¢C� '4�+ i�.,3 4�FS`W3, r���V+�".��� }�''i' � �"ti'°`�.- '�",y .:y;i• �"�, .t' :: � ,}'. � �s�' _,�i� s-..".
"
✓XO
9 1 DAVIE COUNTY HEALTH DEPARTMENT
IMPRON EMENT AND OPERATION PERMITS PROPERTY INFORMATION
Subdivision Name:
Section:
Directions td prgperty..-
�'
IMPROVEMENT
Lot: --
f PERMIT? Tax O fie PIN:#
Road Name6t'U. t 1p:
**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
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE
f # 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) NEW SITE REPAIR SITE y
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fr.�
OTHER
RF.ni 11RFD SITR MODIFICATIONS/rONDMONS:
"*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 # 1S (336)751-8760.
OPERATION PERMIT
"01
SYSTEM INSTALLED BY: O
AUTHORIZATION NO. ! J / OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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 0996 (Revised)
C
i
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WO KSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME Pi �i PHONE NUMBER L �d ` ` �72
ADDRESS( -/J ?lJl SUBDIVISION NAME
/ e-,
l/ SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED ;E� �. JL- INFORMATION TAKEN BY
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