4488 Hwy 158 i
"�i rtttiuse's-=-^ ! DAVIE COUNTY HEALTH DEPARTMENT
Name:" '��/�T_ l� (� Environmental Health Section PROPERTY INFORMATION , /
P.O. Box 848 P 0 Y
Directions to"property: Mocksville,NC 27028` Subdivision Name:
? t r Phone#: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
` - WASTEWATER Tax Office_PIN:# _
SYSTEM CONSTRUCTION \
AUTHORIZATION NO: 2331 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 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
"/'f /' f IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTA'"HEALTH 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
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
lid
**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:
:r...� y
AUTHORIZATION N OPERATION PERMIT BY:-- DATE:.j 1 /4
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
scan ovoz(Revised)
72—
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Z.97 �/
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) y
NAME SOW PHONE NUMBER r 2-
ADDRESS
ADDRESS �'I�k �� Nom, I S� SUBDIVISION NAME
�d�• LOT#
DIRECTIONS TO SITE k.S ' d�' �. E` '•
DATE SYSTEM INSTALLED � NAME SYSTEM INSTALLED UNDER �j •Yin Lkj*.IS crti..
TYPE FACILITY_ HAtLL- NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 1 SPECIFY PROBLEM OCCURRING
DATE REQUESTED 7- INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I unders nd I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193
use'si DAVIE COUNTY HEALTH DEPARTMENT
Name: j/'�41 �ll C tj Environmental Health Section PROPERTY INFORMATION
. .. P.O. Box 848
Directions to property: %t; �r Mocksville,NC 27028 Subdivision Name:
Phone#:336-751-8760
,�� !`'��'� ' r -• `"' .'. E?' (: Section: Lot:
AUTHORIZATION FOR
"•� - �j WASTEWATER Tax Office PIN:# - -
2331
� SYSTEM CONSTRUCTION
AUTHORIZATION NO: 2 3 3 .q i A Road Name: Zip:
a **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)
// / t/ ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
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 - #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD)� NEW SITE REPAIR SITE_
w I
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH LINEAR FT. t�
1
i
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
7
1
1
"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.
i
j
OPERATION PERMIT
SYSTEM INSTALLED BY: 1
j
1
4
i
i
AUTHORIZATION NO. OPERATION 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 02M2(Revised) /
Parcel#: E700000079 Page 1 of 1
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Parcel#: E700000079 Account#:80174000
Owner Information Tax Codes
ILSON LOUISE A ADVLTAX-COUNTY T
488 US HIGHWAY 158 FIREADVLTAX-FIRE TAX
DVANCE NC 27006
Property Information Township
Ess:
(Units/Type): 1.110 AC FARMINGTON
4488 US HWY 158
Deed Information' Local Zoning
ate: 07/1955 Book: 00056 Page: 0543
Plat Book: Page:
Le al Description PIN
1.10 AC HWY 158 5861574923
Pro a Values
uildin 94,62
BXF: 2,35
nd: 3032
Market: 127 29
ssessed: 12729
eferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00056 0543 07 1955 WD Unqualified improved 0
View Property Record for this Parcel View Map 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 factor 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.daviecountyne.gov/itsnet[View.aspx?prid=1478060 6/16/2016