2038 Hwy 158 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FO IMPROVEMENT PERMIT(REPAIR) /
NAME I ' r�i1UT � � PHONE NUMBER-3!5-1
l��tJl�' I��� Pb SUBDIVISION NAME
ADDRESS
J
RL-OT jw�" I c' 717 LOT#
DIRECTIONS TO SITE L! T-
a L,
DATE SYSTEM INSTALLED I� _NAME SYSTEM INSTALLED UNDER
TYPE FACILITY sC NUMBER BEDROOMS NUMBER PEOPLE SERVED �--
TYPE WATER SUPPLY 4 '! SPECIFY PROBLEM OCCURRING
�9
DATE REQUESTED o INFORMATION TAKEN BY
This is to certify that the informapon provided is correct to the best of my knowledge,and that 1 understand 1 am resp s or all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGEN
Rev.1/93
l 4 �,
AUTHORIZATION NO: '132, DAVIE COUNTY HEALTH DEPARTMENT
i Environmental Health Section PROPERTY INFORMATION
' Permittee s .M4ttC..`f `»J'�E„ )��� =.. P.O. Box:848
Name:` C ,r �;� Mocksville,NC27028 Subdivision Name:
5 7 Phone# 336-751-8760
Directions to property`. Section: Lot:
AUTHORIZATION FOR
5c µ-r ' 'QST WASTEWATER
0 Tax Office PIN:# _
SYSTEM CONSTRUCTION
,
Road
: t1a Zip:
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any BuildingPermits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Artiele 11 of G.S.gapter,150A,Wastewater Systems,'Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS,AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD'OF FIVE YEARS.
Rt N L H LT E AL[ T DATE SSU D
a+t,�,.' ! ',�t_�'�:;�°' z++'• r-`- "" -':'^7-s -'ld �` .�f'� 9 ':R i •r wF'*-t�l'�T• <. . t d..r• ..� va�' w,-.,..,w z r r^n# i a",
2DAVIE COUNTY HE4TH DEPARTMENT
�- IMPROVEMENT AND.OPERATION PERMITS PROPERTY INFORMATION k
PetI s M
— Nam ' VV4� f` t 1 na Subdivision Name: 7
Directions to property;" m /" Section: Lot:
x IMPROVEMENT
t4 --:7r PERMIT Tax Office PIN:# " -
�' Road Name t" �.�-': : l {"'�. Zip e d
**NOTE**This Improvement Permit DOES NOT authori e'the construction or installation of aseptic 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
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
IfIb MENTAL HEALTH SPECIALIST-,,., DATE SSU D
ENVTINSTALLING THE SYSTEM.> '
1n �w
RESIDENTIAL SPECIFICATION:BUILDING TYPE tom#BEDROOMS A #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMER1CIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yds or o
LOT SIZE -�9 TYPE WATER SUPPLY ^ DESIGN WASTEWATER FLOW(GPD) lam' L/ NEW SITE—L REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH )'fid LINEAR FT. 2Q:�)�
OTHER" �A� ►-i! IT I G��J ~ CJI ) - -
REQUIRED SITE MODIFICATIONS/CONDITIONS: ' " O{�. t r"" ` f CEE
IMPROVEMENT PERMIT LAYOUT
*APPROVED EFFLUENTFILTER* *RISER(S) IF &" DELOW FINISHED GRADE*
MAY
tow
x
**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(�G4}63�+8#69�•
OPERATION PERMIT <K
SYSTEM INSTALLED BY:
vJIr
l
AUTHORIZATION NO. Z7 OPERATION PERMIT BY: DATE: T I'D 2^
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEMDESCRIBE4ABOVE 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 05/96(Revised)
Parcel#: G500000134 Page 1 of 1
oP�r�
Davie County, NC - Basic Estate Search o0� -
UK
Davie County Web Site
Basic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
_i
Parcel#:G500000134 Account#:40051500
Owner Information Tax Codes
ESSUP MARY N ADVLTAX-COUNTY TA
732 BROWN MOUNTAIN ROAD FIREADVLTAX-FIRE TAX
PILOT MOUNTAIN NC 27041
Property Information Township
Land(Units/Type): 0.400 AC MOCKSVILLE
[Address: 2038 US HWY 158
Deed Information r Local Zoning
Date: 08/1998 Book: 1998E Page: 0207
Plat Book: Page:
Le al Description PIN
1 LOT US HWY 158 5749274973
Property Values
Buildin : 53,77
BXF• 1,02
Land• 12,79
Market: 67 58
ssessed: 67 58
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 OWF98 0207 08 1998 WL Unqualified Improved 0
1998E 0207 08 1998 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
« Return to Basic Search
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=1466908 6/15/2016