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AUTHORIZATION NO: ` 05 1 DAVIE Ci)UNTY HEALTH.DEPARTMENT
'Environmental Health Section PROPERTY INFORMATION
Per—i tee's, P.O.Box 848
,Name. '
Mocksville,NC,27028 Subdivision Name:
// Phone 4- -336
751-"87'60
Directions property: /a2f Section: Lot:
/ AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
Road Name: I✓tea Zip: 21 D
**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/AuthorizationNumber should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 I of G.S.Chapter)30A,WastewaterSyste'ms,Section.1900 Sewage Treatment and Disposal Systems)
f ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
J1., l` `�G�.. .•j A F IS VALID FOR A PERIOD OF FIVE YEARS.
;ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
-77
y ` "� DAVIE COUNTY HEALTH DEPARTMENT'
j.„ IMPROVEMENT AND OPERATION PERMITS 'PROPERTY INFORMATION
;Name:- = Subdivision Name:.
Directionssto property. { ` f -i sy Section: Lot:
j'e > �..% IMPROVEMENT
PERMIT' Tax Office PIN:# - -
r Road Name: d Zip; 2-M Zf
s **NOTE*4 This'ImprovementPermit DOES NOT authorize 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. .
(Incompliance with Article I I of G.S.Chapter 130A,Wastewater Systems Section.1900 Sewage Treatment and Disposal Systems)
4 _ -
• ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER...: ' r
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.:. y, ..
RESIDENTIAL SPECIFICATION:BUILDING TYPE f #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 e!!jt�) DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. .TRENCH WIDTH ROCK DEPTH ZF_ LINEAR Fr-- OZ
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT 1�4'1yE R!__*R_1 ER S IF 6" BELOW FINISIiED GRADE*
SD
**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:
OPERro
sL
Ar'
1 QG7
{ w�
AUTHORIZATION NO.2o OPERATION PERMIT BY: 251w A9
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABUVE 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 BETAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF.TIlKE:
DCHD 05/96(Revised)
n�w
2 �,i C '� DAVIE COUNTY HEALTH DEPARTMENT
w
IMPRO EMENT ANI)OPERATION PERMITS PROPERTY INFORMATION
�er'°`miltee,s ,
r `Name. r. Z Subdivision Name:
Direclions4o property: Section: Lot:
IMPROVEMENT
PERMTT Tax Office PIN:# - -
Road Name: 157Y Zip: 2-26 Zk
**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)
1
E ***NOTICE***TELLS 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
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE_ i� #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 od DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE`..,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH� ROCK DEPTH LINEAR FT.�IZ
1
E. OTHER
`REQUIRED SITE MODIFICATIONS/CONDMONS:
IMPROVEMENT VPERMIT LAYOUT *APPROVED EFFLUENT ILTE1d*��*ItIS£R(S) IF G" BELOW FINISHED GRAD£*
J
SL
**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: �T'tZr^&,jL L)rJ rJ
5
Aai' ��� eve•2 1
X40
last f t,
10j
AUTHORIZATION NO. LOPERATION PERMIT BY: .ter sZ/: 77
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED A E 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. 1
E CHD 05/96(Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME C PHONE NUMBER
ADDRESS 7 SUBDIVISION NAME
2 LOT#
e
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY--N UMBER 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 r'
Rev.1193 s
Parcel#: F600000023 Page 1 of 1
41'-Ic1
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Parcel#:F600000023 Account#: 38612000
Owner Information Tax Codes
HURT ROY EDWARD&HURT 1-ULA B ADVLTAX-COUNTY T
327 US HIGHWAY 158 FIREADVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Property Information Township
nd(Units/Type): 2.740 AC FARMINGTON
ddress: 3327 US HWY 158
Deed Information Local Zoning
�Diate: Book: 00081 Page: 0029
a e:
Legal Description PIN
40AC HWY 158 CORNATZER 5850481851
Property Values
Buildin : 39,83
BXF: 9,19
nd• 3604
Market: 8506
ssessed: 8506
eferred•
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00081 0029 09 1968 WD 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/itsnet/View.aspx?prid=1478632 6/15/2016