1787 Hwy 601NDAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
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NAME PHONE NUMBER !J[ 7SAI
ADDRESS 0S 4toyuvol r SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
3� W 1-47r- jos, SLY DS
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER 5-A r-
TYPE FACILITY R(0� NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY ���'� SPECIFY PROBLEM OCCURRING J=1f')byP
DATE REQUESTED 1 1 05 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 AUTHORIZE A
Rev. 1193 � Y
MR/ �?
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PermitteeLA-
DAVIE COUNTY HEALTH DEPARTMENT
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Name:.)1-��� �---U t 1"s� Q C� • Environmental Health Section PROPERTY INFORMA SON^
P.O.'-Box 848 -
Directions to property: 11. Mocksville, NC 27028 Subdivision Name:
• �-1y Phone #: 336-751-8760
J. Section: Lot:
AUTHORIZATION FOR.
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
.AUTHORIZATION NO: 2250
A. Road Name: 1�`i�r'�3 (t
p:
**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'Buildilag-Egmits. -
(ln comphan '' ith.Article" 1Tof Ci Chapter 1'3 A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
�`�• '
X.DATE
PD�
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONM ZAL fIEALTH SPECIALI
RESIDENTIAL SPECIFICATION: BUILDING TYPE 'Y &t& # BEDROOMS # BATHS 1 # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL'SPECIFICATION: FACILITY TYPE
# PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE I TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
It
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH — ROCK DEPTH LINEAR FT. i l
OTHERI Yi 1� N J ax
REQUIRED SITE MODIFICATIONS/CONDITIONS: �� 1 �T �' • f
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OPERATION PERMIT
WITH ARTICLE 11 OF U.S. CHAPTER 13UA, SEUIIUN .1YW--SEWAUh 111EAIMENI AN1J ll1SYUSAL SYSICMS••, BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. .
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Penr4t,ee,s '� .'• ('.. DAVIE COUNTY HEALTH DEPARTMENTZ
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Environmental Health Section PROPERTY INFORMATION ,
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,. `Uuecuons to property: i r`f� c.,-�. £,.a;
P.O: Box 848
Mocks ville, NC 27028 Subdivision Name:
L)
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR:
,
x 4 11
2250
WASTEWATER
SYSTEM CONSTRUCTION Tax OfficePIN:# - -
' t'Z
::AUTHORIZATION NO A
Road Name: ' # p
**NOTE** This Authorization for Wastewater System
- i
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 wilding -Permits.
and
(In compliance�With Article I 1 of G . Chapter 130A, -Wastewater
Systems, Section .1900 Sewage Treatment Disposal Systems)
`
IuZl��t.'t
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
, r
;r, IS VALID FOR A PERIOD OF FIVE YEARS.
!; 1YIRONM ytAL HEALTH SPECIALIST - DATE ISSU
D
RESIDENTIAL SPECIFICATION: BUILDING TYPE IDt)t�:
# BEDROOMS . = #BATHS #OCCUPANTS�f-- GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
# PEOPLE # PEOPLE/SHIFT # SEATS' INDUSTRIAL WASTE: Yes or No
LOT SIZE' * 4�i' TYPE WATER.SUPPLY ~ " DESIGN WASTEWATER FLOW (GPD) t.% NEW SITE - REPAIR SITE
`. SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH n ROCK DEPTH "�'� LINEAR FT. i
' ,
i I t 3
OTHER
L t r't"' • Lr'r *� L�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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AUTHORIZATION NOJOPERATION PERMIT BY: DATE:
**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 NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVPN PERIOD OF TIME.
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DAVIECOUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name I. % �� , / /'��,�.r*1,?�r�'`� Date
Location
f
Subdivision Name Lot No. Sec. or Block No.
Lot Size House --''� Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family, .�
Garbage Disposal YES ❑ NO ❑� Specifications for System:
'Auto Dish Washer YES NO ❑ .— ,
-.Auto Wash Machine YES [� NO ❑
I Type Water Supply !% ,) '/� - ,'',✓�'
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
I
I
t.
i
Improvements permit by
*.,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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed b
I
i
Certificate of Completion Date
",The signing of this certificate shall indicate that the system described above, has been installed in compliance with: `
I -the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
:may. DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name w Date FL;
Location Y —
,
Subdivision Name
Lot No
Sec. or Block No
Lot Size House f --- f Mobile Home _ Business _— Speculation
No. Bedrooms t --- No. Baths y ' _ No. in Family
Garbage Disposal YES ❑ NO ❑-` Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES d NO ❑ J
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed
Certificate of Completion _ Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with_
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
r . DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name _ ! w ,: _�. Date
Location
Subdivision Name Lot No. Sec. or Block No
Lot Size House Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths % No. in Family
Garbage Disposal YES D NO pE] Specifications for System:
Auto Dish Washer YES D NO D
Auto Wash Machine YES [rj NO p f'
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed bye'
Certificate of CompletionDate
"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
Parcel #: H400000004
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: H400000004
Account #:62612000
Owner Information
Building:
Tax Codes
BXF•
RUMAGE JOHN D& RUMAGE HAZEL FAYE
Land:
I IC ADVLTAX -COUNTY T
Market:
1787 US HIGHWAY 601 NORTH
assessed:
READVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 1.690 AC
Fddress:
MOCKSVILLE
1787 N US HWY 601
Deed Information
Local Zoning
Pate: 01/1955 Book: 00056 Page: 0251
Plat Book: Page:
Legal Description
PIN
1 LOT HWY 601
5729766544
ProveProvertv Values
Building:
71,4001
BXF•
3,92
Land:
34,93
Market:
110 25
assessed:
110,25
Deferred:
Sales Information
No. Book Page Month Year Instrument Qua[/UnQual Improved Price
J. 00056 0251 01 1955 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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Davie County Web Site
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=1464086 8/23/2016