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9!t� Alldata is provided as Is without warranty or guarantee of any kind 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
�olll 1\ 1�T C or arising out of the use or Inability to use the GIS data provided by this website.
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Parcel Information
Parcel Number:
J7120A0012
Township:
Fulton
NCPIN Number:
5777280593
Municipality:
Account Number:
25838000
Census Tract:
37059-804
Listed Owner 1:
FORK VOLUNTEER FIRE DEPARTMENT
Voting Precinct:
FULTON
Mailing Address 1:
3514 US HWY 64 EAST
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class: DAVIE COUNTY R -20,H -B
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
2.360 AC HWY 64
Fire Response District:
FORK
Assessed Acreage:
2.36
Elementary School Zone:
CORNATZER
Deed Date:
4/2005
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
006010545
Soil Types:
PcB2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
101360.00
Outbuilding 81 Extra
760.00
Freatures Value:
Land Value:
33450.00
Total Market Value:
135570.00
Total Assessed Value: 135570.00
9!t� Alldata is provided as Is without warranty or guarantee of any kind 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
�olll 1\ 1�T C or arising out of the use or Inability to use the GIS data provided by this website.
PermitteeIs DAV
IE COUNTY HEALTH DEPARTMENT
Name: f uC� [� / "�V7if/G(lvironmental Health Section PROPERTY INFOR�'�7jI u1''
j P.O. Box 848 vI
Directions to property: �' ' �Mocksville, NC 27028 Subdivision Name: i
.Phone #: 336-751-8760
Section: Lot:
I V K I' 0i[Wi l AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
fidva%ve� � SYSTEM CONSTRUCTION l - -
AUTHORIZATION NO: "' (1 1`l Road Name:�jZ�`�(!(-: Wi
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pen -nits. 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)
` t***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE & # BEDROOMS T # 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 t DESIGN WASTEWATER FLOW (GPD.) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �� r LINEAR FT.'��J ��
As stated in 15A NCAC 18A.1969(5)
OTHER accented Systems ^11y plso hn tfn-
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
�X
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT 1'\ 1�
Sid EM INSTALLED BY:
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ck
400 wl'tiv—w-ir
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AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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 02/02 (Revised) 1q&19 ofi000 z (s —/ .� �� JOP; I l! `t
I�
to 4 e --
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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 02/02 (Revised) 1q&19 ofi000 z (s —/ .� �� JOP; I l! `t
_Pernu'ttee's`. �� 2 DAVIE COUNTY HEALTH DEPARTMENT U�
�//c,.,/environmental Health Section PROPERTY INFOR @I�
U- P.O. Box 848
Directions to property: t r Mocksville, NC 27028 Subdivision Name:
' „Phonq #: 336-751-8760
Section:_
1 0 % /—OR j- V /) �J ef({fZ ttf AUTHORIZATION FOR
,� — WASTEWATER
vae� SYSTEM CONSTRUCTION
lqd/V-
AUTHORIZATION NO: 002698 A
Lot:
Tax Office PIN:# - -
Road Name: rVRL �� �f 27b(lo
**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 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)
r ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE _& # 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) `1 (/ NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ._ ROCK DEPTH /' LINEAR Fr.J�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
t
fyt
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT � SYYSTEM INSTALLED BY:
G�
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deo
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Y
AUTHORIZATION NO. Z 0 �l 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.
DCfiD02/b2(Revised) Ann# 6919oa�q�� �,�. � 7 J
3;WA .3514 as //Wy E Alelat(lne /I, 6- 77dr �
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �/ /
i APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) &a4/iaxj J �}"0l-
ADDR
DIRECTIONS TO
VF6.
461
PHONE NUMBER
,ie/ 2'7066
SUBDIVISION NAME
LOT #
A/ i2al
hoa�e_ pAj k4ll
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER A/ '
TYPE FACILITY LC -e- NUMBER BEDROOMS NUMBER PEOPLE SERVED
PE WATER�Y)PPLY a a � PECIFY PROBLEM OCCURRING a e, ( (4 � Gt,,/dL
M76 V 4J
DATE REQUESTED INFORMATION TAKEN BY /Lu
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT/ dg`I- 0 �V_
Rev. 1/93
CO 183
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