2104 Hwy 158kTHORIZATION.NO: 8 8 4 DAVIE COUNTY HEALTH DEPARTMENT PC 11
Environmental Health Section PROPERTY INFORMATION
Permittee sP.O. Box 848
MY Mocksville, NC 27028 Subdivision Name:
Phone# 336-75178760
Directions to property: Section: Lot:
AUTHORIZATION FOR
WASTEWATER
Tax Office PIN-.*#
SYSTEM CONSTRUCTION
Road Name: Zip:
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 Pen -nits.
(In compliance with Article 11 of G.& Chapter 130A, Wastewater 'Systems, Section :1900 Sewage Treatment and Dis
posal Systems).
NVI,RONM
�-�
AUTHORIZATION NO OPERATIONFERMIT Two'DATE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME ��--�-� O'e4c'� N PHONE NUMBER � � �3,1 �.
ADDRESS 1 a SUBDIVISION NAME
e-C�S
,/I 11t_ AJ C- LOT #
DIRECTIONS TO SITE 1 .-rQ a�►-i o r C l� %'1-� C ?3 �"j 23-2 �tJ
e� n: Lj
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER ?
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY v SPECIFY PROBLEM OCCURRING U,
DATE REQUESTED o INFORMATION TAKEN BY LQ
This is to certify that the information provided is correct to the best of my knowledge, and that I understand 1 am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
Parcel #: G50000013304
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Parcel #: G50000013304 Account #:53948000
Owner Information
Building:
Tax Codes
BXF•
CHOLS ELLA GRACE
Emii(OCKSVILLEr
Land:
ADVLTAX - COUNTY TA
Market:
04 US HIGHWAY 158
ssessed:
FIREADVLTAX - FIRE TAXNC
[Deferred:
27028
Unqualified
Vacant
Property Information
2
Township
Land (Units/Type): 0.780 AC
01
MOCKSVILLE
ddress: 2104 US HWY 158
Vacant
3,500
Deed Information
OOOBY
Local Zoning
ate: 12/2015 Book: 2016E Page: 0009
1900 WD
Unqualified
Plat Book: Page:
3,500
4
Legal Description
0661
PIN
1.09 AC HWY 158
Unqualified
5749286776
Property Values
Building:
Page
BXF•
9,8301
Land:
20,24
Market:
30,0701
ssessed:
30.,0701
[Deferred:
1900 WD
Sales Information
No.
Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
1
00087
8700
01
1900 WD
Unqualified
Vacant
3,500
2
OOOBY
0000
01
1900 WD
Unqualified
Vacant
3,500
3
OOOBY
1990
01
1900 WD
Unqualified
Vacant
3,500
4
00136
0661
04
1987 WD
Unqualified
Vacant
3,500
5
2016E
0009
12
2015 EF
Unqualified
Vacant
0
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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=1430081 16/8/2016
AUTHORIZATION NO: 07 37 i
DAVIE
Name:--� h• F+i1V11' �1��jD• ���'���'��
Directions to pro ti gala �C� �nmental x�
Proper 0 P, it alth
o. g Sept
MOcksvil ox 84g ��n 1 ",
Phone #, 764, 27028
1Vp ** �usqu\ q, `�.. �9 5 SUTI�D�ZA o 8�6� Spbdivlsioa N ER 'INFp �TU(j ` ; o
to iss
Lith \ c TEMH'A FOR 3e Vie: ON ��
O trance Of bon for CpNSTit ction..
°mPliancew When aPp 'lay yinWl�ngPOf
ewaterSysten,pN . ?ax
( ell o G S Bvildu?S Ps F nn/.q'ct'�n 11� a/Olce PIN'# LOt
\�aPter13ts thoq��o STgEIs RoadNa
V] IVNjENT� HEAL Oqwastewater S n Numver hod by the Dav me: ' t��- -
SPECIgLIST DAtw
A -rj*No terns, Secon 1ShePresentedto Dvie
! vuoen Zlp \
ISSD TICS*** wage Tri ¢, a Copexth
9 �Tpe
llp net and Dis t1' Building Insection Prior
�'ALIDF pA�� N R w Posh SysterPIS�aOns
Rip OFA SVETEWA _ R C
YEq O�rS1
RUQ 0N
VX OµeFi
DAVIE COUNTY HEALTH DEPARTMENT ,
�1
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION—
` -
R Peumuttee'
. wName: 1- 4'� s •c.a �`��3 - cid Subdivision Name:
Diri� iong`to property: `' 1 Section: Lot:
I1WPROVEN1Uff
PERMIT Tax Office PIN:# _
.' . e Ro d`N 1-7` Zip:t' tt
**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*** TEIIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE rAHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMTT'$EFORE
INSTALLING THE SYSTEM. l s;
RESIDENTIAL SPECIFICATION: BUILDING TYPE% �)6 # BEDROOMS # BATHS # OCCUPANTS GARBAGE DI ,OQSAL: Yes `'Fib
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WSTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH r LINEAR FT. i . + 0 '
OTHER ,
REQUIRED SITE MODIFICATIONS/CONDITIONS:
t
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM'
BETWEEN 8:30 - 9:30 A.M. OR I:00 - 1:30 P.M. ON THE DAY AF INSTALLATION. TELEPHONE # IS (704) 634-8760.
DCHD 05/96 (Revised)
'�� t3 �� '°r 1`Y r^;� �1^'' "'���. 'ro.,« .,. ,:�. '�ti r�`'. .'i, r "" ';?...!�.',,t' �y�� ;�� 's�''r; ��� j � •���0 'P
DAVIE COUNTY HEALTH DEPARTMENT`
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION '
" Pe ttee's
Name: Subdivision Name:
Directiong`to property: t t Section: Lot:
BIPROVEMENT
PERMIT Tax Office PIN•#
A/0V
Koad Name: i 7> Lap: Aj>
**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)
f ***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
INSTALLINGTHE SYSTEM.., t.+
YW
RESIDENTIAL SPECIFICATION: BUILDING TYPE'J�� .lam # BEDROOMS # BATHS # OCCUPANTS � GARBAGE DIS
VOSAL: Yes do Ido
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIM TYPE WATER SUPPLY' DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. 1 `"'
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BET TEN 8;30 - 9;30 A.M. OR 1:00 - 1:30 P,M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
AUTHORIZATION N0. �✓ 1 OPjtATION PERMIT BY: .i��N`� DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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)
°'-°
V -f L'W'11-1
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME (rr6t-Ce-.,/" ISIS PHONE NUMBER
ADDRESS o Id # As Z-67 SUBDIVISION NAME
0-.� V. LOT #
DIRECTIONS TO SITE 67 - /� 1� - D ?�� y
ro4 "iJ-1- o -14-4n W-4railer - ren-,n6k
DATE SYSTEM INSTALLED d-7" NAME SYSTEM INSTALLED UNDER 71411-1116Z )X-I-Vhlya e
TYPE FACILITY / er NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING �lG2C jlzxp
r mac, b-,� C .
DATE REQUESTED ��INFORMATION TAKEN BY_
This is to certify that the Information provided is correct to the best of my knowledge, ,and that I understand I am responsible for al charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT_G
Rev. 1193