1930 Hwy 158i� .. '.,, C4 �vn.�l(/i•'t'"5 p,.trw5.` Y'`r"A'�r•1 ir*Y:.,s�•� i�7..%i'c.-Mbi,;,.ia.+ira s`�..,�•..iiv.Vries-;;sy,h;.�..,Mvy�{�.r..P,.;„•..-c:'^'�.liTi'�.'x,. v .. -_..
��/ ✓ /�, 6
DAVIE COUNTY HEALTH DEPARTMENT
JA
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
n nitary Sewage Systems Permit Number
V •- ryl� � /fir / '7 �1
Name /W VDate �2!:� �'� N0 t 7 3 V
Location
Subdivision'Na/mee Lot No. Sec. or Block No.
Lot Size %J�B� House Mobile Home _— Business __ Industry
No. Bedrooms No. Baths —cam No. in Family_ Public Assembly Other
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma^hive YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
/;-!/ ; n o,ld 7.4 ke
Improvements permit by — Z42
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704634-5985.
Final Installation Diagram: System Installed by _96
Certificate of Completion Date
'The signing of this certificate shall 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.
ted... .-a.Y ": .r. .r ._�..-� h.'\.. .. P\lY.., ..,5 •'-•--M+.-�1-'.4 i.�a.�l r'4' . �1 Y •. .•- _ . -..
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
Y
� OTE: Issued in_Compliance-With Article 11 of G.S. ChaAter 130a
nitary Sewager Systems Permit Number
Name J�1��L �����Vy/Date1.i'NO7730 j
Location
17
Subdivision Name / Lot No. Sec. or Block No.
Lot SizeHouse f'" Mobile Home -T Business -- Indus ry
;t
No. Bedrooms No. Baths _L_ No. in Family— Public Assembly ,Other
Garbage Disposal YES ❑ NO ❑ "k Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma^hine YES ❑ NO ❑ e -q y e
TypeWater SuPPIY
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
Z7
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by &
�i
Certificate of Completion Date
"The signing of this certificate shall 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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By
Mailing Address 19 3(C)
o C,L's I/„ U Business Phone
2. Name on Permit if Different than Above
3. Application for: �El General Evaluation P3Septic Tank Installation Permit
1E/
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
No. of People 1
No. of Bedrooms CQA�
No. of Bathrooms Si `UUA—
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers.
No. of Showers Water Usage Figures.
7. Type of water supply: Public ❑ Private
�l
8. Property Dimensions I .3 Sewage Disposal Contractoi
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If vac what tvna?
❑ Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ No
❑ Community
"NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
This is to certify that the information provided is
incurred from this application.
1-2.0-6)41
DATE
to th best of y knowledge, a understanN am responsible for all charges
LCJJO�,
SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD'(1/93)
Parcel #: H500000028
Davie County,. NC - Basic Estate Search
U
Basic Search Real Estate Search Tax Bill Search Sales Search Q
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: H500000028
Account #:82517555
Owner Information
BXF:
Tax Codes
Land:
CCULLOH GREGORY R& MCCULLOH KAREN M
Market:
ADVLTAX - COUNTYTA
ssessed:
1930 US HIGHWAY 158
[Deferred:
FIREADVLTAX - FIRE TAX
OCKSVILLE NC 27028
Property Information
Township
FLand (Units/Type): 1.090 AC
MOCKSVILLE
dress: 1930 US HWY 158
Deed Information
Local Zonin
Date: 09/2001 Book: 00387 Page: 0426
Plat Book, Page:
Le al Description
PIN
1.300AC HWY 158
5749264387
Property Values
Buildin :
9084
BXF:
35,41
Land:
25,5201
Market:
151,7701
ssessed:
151,7701
[Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00387 0426 09 2001 WD Unqualified Improved 0
2 00172 0842 02 1994 WD Qualified Improved 70,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
<< Return to Basic Search
Page 1 of 1
vN.1�
01-0014--111:
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 merchantability 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/itsnet/View.aspx?prid=756391 6/8/2016