2646 Hwy 158 Perrnitiee's / DAVIE COUNTY HEALTH DEPARTMENT.
An
e: <1/' j .k Environmental Health Section PROPERTY FORMATI
� � .P.O. Box 848
Directions to property �_ 'a, � ! 'P Mocksville,NC 27028 Subdivision.Name:
L / Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER _
je SYSTF,M CONSTRUCTION Tax Office PIN:#
AUTHORIZATION NO: 1 ! A 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 I 1 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
am/ IS VALID FOR A PERIOD OF FIVE YEARS.
ENV ONMENTAL0EALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS. #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) .NEW SITE REPAIR SITE
,r
SYSTEM SPECIFICATIONS: TANK SIZEGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1 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#1S (336)751-8760.
OPERATION PERMIT /�
SYSTEM INSTALLED BY: 74A
10
AUTHORIZATION NO. OPERATION PERMIT BY: DA
**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 o7!(r1(Revised) ' f '
t DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
f_ APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) G
NAME �_. /loL� � _ PHONE NUMBER
.j
ADDRESS �(P �f C. �-S -c.�� /S SUBDIVISION NAME
C-111-'5 L/ /i __ LOT #
DIRECTIONS TO SITE S C SC-++��
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER )4 AC.I
t<.
` TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED 2-
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING t �►�^ .�c S
DATE REQUESTED✓ INFORMATION TAKEN BY 1
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.1193
Parcel#: G500000079 Page 1 of 1
oP�r�
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Parcel#:G500000079 Account#:34692000
Owner Information Tax Codes
ENDRIX BILLY LESTER SR&HENDRIX REBECCA H ADVLTAX-COUNTY T
49 DULIN ROAD FIREADVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Property Information Township
rand(Units/Type): 1.300 AC MOCKSVILLE
loAddress: 2646 US HWY 158
Deed Information Local tonin
ate: 09/2012 Book: 2012E Page: 0914
lat Book: 0002 Page: 025
Le al Description PIN
OTS 7-13+87-89+P/0 86+14 5840646551
Property Values
Building: 103,8801
BXF• 2,9901
Land: 26,6501
Market: 133 52
Assessed: 133,52g
Deferred: 01
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00444 0670 10 2002 WD Unqualified Improved 0
2012E 0914 09 2012 DC 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=1460196 6/14/2016