2129 Hwy 158 Permittee s f �' e' DAVIE COUNTY HEALTH DEPARTMENT/
Ni►me: .* z C Environmental Health Section PROPERTY INFORMATION
` / P.O.Box 848
Directions topropeity� li/�!!�f r� �� f��;�gocksville;NC 27028 Subdivision Name:
I 6hone#:336-751-8760
Section: Lot:
/ AUTHORIZATION FOR
r�, ,`y / d,�/�i'• /� f +,� WASTEWATER Tax OfficePlN:#
SYSTEM CONSTRUCTION
r AUTHORIZATION NO: 2342A 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 Permits.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.]900 Sewage Treatment and Disposal Systems)
f/ ,( ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
f%�.;f`s''. ,�;� !<J� -7 -?✓ '�� ;, „`,,1 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- #SEATSINDUSTRIAL WASTE:Yes or No
/
LOT SIZE TYPE WATER SUPPLY F�/ DESIGN WASTEWATER FLOW(GPD) NEW SITES REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH c�S� CROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**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 (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: <
AUTHORIZATION
NICEtVIIIERATION 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 02102(Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME____. Odes G✓/ ' S PHONE NUMBER
ADDRESS 1_9T SUBDIVISION NAME
r z_ r LOT#
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY ,W_e.2! SPECIFY PROBLEM OCCURRING
DATE REQUESTED G�� INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that 1 understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193
Parcel#: G500000029 Page 1 of 1
0VI
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Parcel#:G500000029 Account#:82517536
Owner Information I Tax Codes
LES OLLIE MAE ETAL&BOWLES LARRY GILBERT ADVLTAX-COUNTY T
EM18ICKSVILLE,
9 US HIGHWAY 158 READVLTAX-FIRE TAX
NC 27028
Property Information Township
nd(Units/Type): 0.850 AC MOCKSVIL-E
ddress: 2129 US HWY 158
Deed Information Local tonin
Date: 06/2015 Book: 00991 Page: 0820
lat Book:
age:
Legal Description PIN
1.13 AC HWY 158 5749295058
Property Values
Building: 95,00
BXF: 01
Land: 21,6901
Market: 116,6901
ssessed: 116,6901
Deferred: 01
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00386 0801 09 2001 WD Unqualified Improved 0
00386 0802 09 2001 WD Unqualified Improved 0
00678 0361 09 2006 WD Unqualified Improved 0
00678 0364 09 2006 WD Unqualified Improved 0
00753 0421 04 2008 QC Unqualified Improved 0
ra 00991 0820 06 2015 QC Unqualified Improved 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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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/itsnetfView.aspx?prid=1419705 6/9/2016