3492 Hwy 158Permittee s DAVIE COUNTY HEALTH DEPARTMENT
aml ei•.J�-, r; Environmental Health Section PROPERTY INFORMATION
11 r, P.O. Box 848
Due tions to property: J 'i "< /L:'I, i /C` Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
/r ;•'- f � 1-" �i � / Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 2140 A Road Name: Zip: o? 7v.1s'
��Office
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
when applying for Building Permits.
(In compliance with Article I 1 of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSOED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE "%J"'-- # PEOPLE # PEOPLE/SHIFT # SEATS Ono INDUSTRIAL WASTE: Yes o No
LOT SIZE TYPE WATER SUPPLY ` O DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH Mr ROCK DEPTH d6E LINEAR FT..re�?/S
REQUIRED SITE MODIFICATIONS/CONDITIONS:
.c. {: ,-� •*" ' ,, y •• .v , r'`• a :^ , „ ' '" r ^ - 'iii ro .._, 45...,,"
Ti-' � Perrruttee'; � D VIE COUNTY HEALTH DEPARTMENT f
Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Dirct ions to property. mG / Mocksville: NC 27028 Subdivision Name:
Phone #: 336-751-8760
o , [:'Z, LaU.l Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION214 01,
- -
AUTHORIZATION NO: A Road Name:
7c��81
**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)
/ f / ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENV RONMENTAL HEALTH SPECIALIST DATE ISSOtF
RESIDENTIAL SPECIFICATION: BUILDING TYPE/���' # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPTr ''N# PEOPLE # PEOPLEISHIFT # SEATS QQ INDUSTRIAL WASTE: Yes o No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE - REPAIR SITE i
A
/,SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL.' TRENCH WIDTH ROCK DEPTH LINEAR FT.O/�
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
* C
TA 1NJATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
EN 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:
is
AUTHORIZATION NO. PERATION PERMIT BY: DATE:
__�2 zo_
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIAN E
WITH ARTICLE 1I 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.
Dcan 02/02 (Revise
". DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME i �Ji /'DJY -PHONE NUMBER
ADDRESS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
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 all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
Parcel #: F600000055
Davie County, NC - Basic Estate Search
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Parcel #: F600000055 Account #:67271750
Owner Information
Buildin
Tax Codes
BXF•
MITH GROVE METHODIST CHURCH
Land:
ADVLTAX - COUNTY T
Market:
492 US HIGHWAY 158
ssessed:
FIREADVLTAX -FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 6.870 AC
FARMINGTON
ddress: 3492 US HWY 158
Deed Information
Local Zoning
Pate: 01/1924 Book: 00027 Page: 0285
Plat Book: Page:
Legal Description
PIN
00 AC HWY 158
5850691649
Prope Values
Buildin
926,94 0011
BXF•
10,77
Land:
92,44
Market:
1,030,15
ssessed:
1,030,15CI
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00027 0285 01 1924 WD Un ualifled Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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
h4://maps.daviecoutitync.gov/itsnetfView.aspx?prid=1469131 6/8/2016