4209 Hwy 158 -c. i'- 1.,r. .�-�+,� ,'� :i r.., ,� 4''•�ar =;7':s `t"w/� , a..... a 'r u„ . ..:��,� -..
Permittee'sr� DAVIE COUNTY HEALTH DEPARTMENT' r °�
Name: 14414 Environmental Health Section- PROPERTY INFORMATION
K- P.O.Box 848
Directions to property: /S�� / ` �-�j-�lf L Mocksville,NC 27028 Subdivision Name:
" -r Phone#: 336-751-8760
E Section: Lot:
r AUTHORIZATION FOR
WASTEWATER -
SYSTEM CONSTRUCTION Tax Office PIN:#
AUTHORIZATION NO: 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 coml
iance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
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ZX( ( . ,//- ,' IS VALID FOR A PERIOD OF FIVE YEARS.
rr
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS--"-? #BATHS #.00CUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT f� #SEATS INDUSTRIAL WASTE: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 WIDTHL� ROCK DEPTH /"LINEAR Fr( U
Aff
OTHER_p
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
,.S'7iq S'17���orn
**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 ._ /�y,✓ �
SYSTEM INSTALLED BY:
�a
l eD
+
AUTHORIZATION NO9 OPERATION PERMIT BY: DATE: �� b l
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE i I OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA .
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILYTOR ANY GIVEN PERIOD OF TIME.
DCHD 02N2(Revised)
n C 4L w tt1r r.. I�rt+
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
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NAME iYrta �. 6uq#*,.-w Wait, PHONE NUMBER 331--ftlk- 1 R 91
ADDRESS SUBDIVISION NAME
W •S "2-"11 04 �•Fh } 1• rt— -1nb4c) LOT # /
DIRECTIONS TO SITEIS-tr- 4k& T S y,;+L, 01 6 _.c-iL �ty44t 1447
v
DATE SYSTEM.INSTALLED " NAME SYSTEM INSTALLED UNDER eec,Ita
TYPE FACILITY I}wcct_ NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED Z
TYPE WATER SUPPLY CCI• SPECIFY PROBLEM OCCURRING "ra,.t- 6 4uw n"s Full f- VJ4
1 S cc...s�-�' �L�.��y [�,n�.� �i ti 1�►.�o�.u. Z��...1�. ,�. S Gti,:1cQr�. 1•►..,�t ,L h v►�.�
DATE REQUESTED 3 � INFORMATION TAKEN BY_ � 1
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.1/93
Parcel#: E600000095 Page 1 of 1
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Parcel#:E600000095 Account#:82525346
Owner Information Tax Codes
ONES JEFFREY A ADVLTAX-COUNTY T
176 KNIGHTS LANE FIREADVLTAX-FIRE TAX
ADVANCE, NC 27006
Property Information Township
Land(Units/Type): 0.570 AC FARMINGTON
Address:4209 US HWY 158
Deed Information Local Zoning
Pate: 11/2005 Book: 00633 Page: 0271
Plat Book: Page:
Le al Description PIN
1.680 AC HWY 158 5861178064
PropertvValues
uildin : 133,00
BXF:
nd: 17,19
Market: 150 19
ssessed: 150 19
eferred: cl
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00423 0213 05 2002 WD Unqualified Improved 80,000
00598 0704 03 2005 WD Unqualified Improved 0
00619 0714 08 2005 WD Unqualified Improved 77,500
00621 0001 08 2005 WD Unqualified Improved 0
00633 0271 it 2005 WD Unqualified Improved 0
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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
hap://maps.daviecountync.gov/itsnet/View.aspx?prid=1459381 6/16/2016