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AUTHORIZATION NO: 0654 DAVIE,COUNTY HEALTH DEPARTMENT
4:.
Environmental Health Section PROPERTY INFORMATION
Permittee's P.O.Box 848
Name:" Mocksville,NC 27028 Subdivision Name:
l`�5J Phone#:704-634-8760
Directions to property: SSS Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office SYSTEM CONSTRUCTION 00.7 d
Road Name: J�3 Zip:. 0 0
*.*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
i Office when applying for Building Permits.
compliance with Article i 1 of G.S.Chapter 130A,Wastewater Systems;Section.1900 Sewage Treatment and Disposal Systems)
f ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
t
L' IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALT PECIALIST, DATE ISSUED
'�.dyrur 3 �-.. >� 1"` 'eti S. ,;':,'t4,� nrr<�i x�. •i'+� �.. .« v^rt,i r,.; v «, .tfi 'i�,. i.. ...�,,1,-?h, :,yrY,- - .. v..,r„, .. - `��> Q.
DAVIE COUNTY HEALTH DEPARTMENT i
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
�ermlttge s °�' �
`,NSubdivision Name:
Directions to property: -� (`t Section: Lot:
IMPROVEMENT
' PERNU Tax Office PIN:#
Road Name: 1457 Zip: Id 0
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
eAUTHOR17ATMNFDR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
pliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEAL SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
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 tel!/ROCi,'DEPTH��LINEAR FI7.I�
a = y" C
OTHER
?REQUIRED SITE MODIFICATIONS/CONDITIONS:
;
IMPROVEMENT PERMIT LAYOUT
C
Wt
**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(704)634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
SS
S0
i
a vs�
f3
AUTHORIZATION NO. 1 OPERATION PERMIT BY: DATE: y ��
**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 05/96(Revised) . . t`
i e:*: r: t 1 i,n rr:g.Yr*• -F,"� •h"e...�.` < ,......•...,..�` - ..': — _:.-rrj,
4' �Jf t e�',ti f,a. d 1-�'e�rc,.c a�,r�t",t .. -1 ` 'j'};-p tin -_F a, r . ' •' a�•.-. �"i-, _
r• ^
)<
Z,
- - - DAVIE COUNTY HEALTH DEPARTMENT
-p�`w ��. ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
ermlyee's"1
Name Gr t r~ f r r:: f✓s' t Subdivision Name:
Directions to property: J r' Section: Lot:
1MPROVEMENT
i PERMij
y Tax Office PIN:# - -
Road Name: Zip'
**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.
compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
r.. ;'•;° � ! f`fy/ /F� 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 #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.<
; v
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
r
tvt!�
�rive
.F
**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(704)6348760.
J
OPERATION PERMIT
SYSTEM INSTALLED BY: J3"
SS
._..._._�..
'So�
r
4
r
a
AUTHORIZATION NO.G OPERATION PERMIT BY: DATE: _9-7
**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 05/96(Revised) f -
i
r
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) / ,(
NAME PHONE NUMBER %�✓ ��! 2eJ
ADDRESS _ �D/� US's/ ,�5 SUBDIVISION NAME
�«�/�l✓Cfl� Of/•!.�% LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 11-104
SPECIFY PROBLEM OCCURRING
DATE REQUESTED _2110 9 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 h as incurred from this application.
14". diz (V
SIGNATURE OF OWNER OR AUTHORIZED AGENT •
Rev.1193
Parcel#: D700000198 Page 1 of 1
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Parcel#: D700000198 Account#: 82525943
Owner Information Tax Codes
AHORY SARAH CALL ADVLTAX-COUNTY T
308 GUILDBROOK ROAD FIREADVLTAX-FIRE TAX
CHARLOTTE, NC 28226
Property Information Township
FLand (Units/Type): 1.000 AC FARMINGTON
dress: 5005 US HWY 158
Deed Information Local Zoning
Date: 07/2007 Book: 2007E Page: 0213
Plat Book: Page:
Legal Description PIN
1.00 AC HWY 158 5872111549
Property Values
Building: 26,7201
BXF: 01
Land: 25,74
Market: 52 46
ssessed• 52,46
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
00054 0624 06 1954 WD Unqualified Improved 0
2006E 0058 12 2005 WL Unqualified Improved 0
2007E 0213 07 2007 WL 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 verif=ication 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=1474743 6/15/2016