2421 Hwy 601NDavie County Health Department
§'*113,6' Environmental Health Section '
P.O. Box 848
lk
E" E':'� 210 Hospital Street• Courier # : 09-40-06 1911
Mocksville, NC 27028
Phone: (336) - 753 - 6 f - - ciu: 1FE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
Name: Y l Q' Q11-4-jkn Phone Number 33(o (-PoC '59 J (Home)
Mailing Address: PC� �j�{ I�� (Work)
uUCs[/�l�o NG -70 ->D Email Address:
Detailed Directions To Site: �¢. (�( IJ A�S-l" C, �5 o*" wL- Wk—lrt-3 AgyPS
Property Address: m zl U� �q73 �� �(�o/i6
Please Fill In The Following Information About The EXISTING Facility: Cha ri1SVi ���— Z
Name System Installed Under: C_1 e,[[' � /��7U dJa- �0 N Type Of Facility: MH
Date System Installed (Month/Date/Year): Number Of Bedrooms:yr Number Of People:
Is The Facility Currently Vacant? YesNo' If Yes, For How Long?
Any Known Problems? Yes (No)If Yes, Explain:
Please Fill In The Following Information About
bout The NEW Facility:
Type Of Facility: 120%� 4X& *010 Number Of Bedrooms: Number of People.
Pool Size:
Requested By:
Approved Disapproved
ents:
Environmental Health Specialist
Garage Size: Other:
f= Date Requested:
For Environmental Health Office Use Only
Date:
*The signing of this form by the Environmental Health Staff is in4no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check
Paid By:_
Money Order # Amount:$
Received By:
Account #: 5"/ &' Invoice #:
Date:
Davie .County Health Department
y.
0 X18 Enviro. ntal Health Section .
P.O. Box 848
0% , , .5 -i 210 Hospital Street
Courier # : 09-40-06 1911
!�1 Mocksville, NC 27028
Phone: (336) -71753-f6780 T ON-SITE WASTEWATER CERTIFICATION. Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
Name:, -A{ or -A_ a t-,t,i4:�P� Phone Number 33(fl OQ 59Z3 (Home) .
Mailing Address:10l�) (�( S ( (Work).
Email Address:
Detailed Directions To Site: (Le. Jv (IJ 4a" r"C I5 Ncere
V11 Oki- 0LA-✓(",161,-1 . M<j le .0
Property Address:' Z ZI U 11 y lY r73 � q OA . 00 1,4e
Clarltsville-= Z
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: e (I ` `10 Al d a �{f/.�]�"..//-0 N Type Of Facility:
Date System Installed (Month/Date/Year): 1q`'7 b Number Of Bedrooms:__2__Number Of People:_
Is The Facility Currently Vacant? YesNo If Yes, For How Long?
Any Known Problems? YesNo , If Yes, Explain:
Please'Fill In The Followiin/g, Information About The NEW Facility: -
Type Of Facility: ��17 (%V 1 X t /20N 41 Number Of Bedrooms: _ Number of People ' .
Pool Size: "'Garage Size: Other:
Requested By: Date Requested:
(Signature) `
�rApproved Disapproved
For Environmental Health Office Use Only r, { V
cunffhents: '
r
Environmental Health Specialist ( �" �� Date:
*The signing of this form by the Environmental Health Staff is in,no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any give enod of time.
"Payment: Cash Check -A Money Order # Amount:$
Paid By: Receive By
/� t
Account #: t!5 7 0 1 t', �� �1'� l Invoice #:
'4c
-, I
� lT
IMPROVEMENT PERMIT
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
*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)
NAME .^J�'/��.1 LTJ/�/?!�/I PROPERTY ADDRESS (AD� �. off+ I Q 0 DATE 6�Z
LOCATION
SUBDIVISION WE )'I" ea /iY IG�L, LOT NUMBER i SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS -�/ GARBAGE DISPOSAL: Yes(t�
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE _ # PEOPLE/SHIFT _ # SEATS _ INDUSTRIAL WASTE: Yes/No
LOT SIZE _� TYPE WATER SUPPLY _ DESIGN WASTEWATER FLOW (GPD) rZ� NEW SITE [/REPAIR SITE _
SYSTEM SPECIFICATIONS: TANK SIZE tlaQ GAL. PUMP TANK GAL. TRENCH WIDTH , / ~ ROCK DEPTH /_.2 • LINEAR FT. -0,0
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
+m+THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY� �1
}*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT R FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. EPHONE t IS (7 4) 634-8760.
OPERATION PERMIT I0 SYSTEM INSTALLED B !✓)' ,CCr�)z
ty
ell of
IL
�p\ x poled
AUTHORIZATION NO. OPERATION PERMIT BY � DATE 1Q�
*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.
Parcel #: G304OA0001
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 #: G304OA0001 Account #:8302457
Owner Information
Building:
Tax Codes
BXF•
1W8sv�l BANK NATIONAL ASSO
Land:
ADVLTAX - COUNTY T
Market:
1 FREDERICA STREET
ssessed•
FIREADVLTAX - FIRE TAX
[Deferred:
ENSBORO KY 42301
Property Information
Township
Land (Units/Type): 1.000 LT
CLARKSVILLE
ddress: 2421 N US HWY 601
Deed Information
Local tonin
Date: 08/2016 Book: 01025 Page: 0987
Plat Book: 0006 Page: 155
Le al Description
PIN
LOT 1 REED PATCH
5820541122
Property Values
Building:
43,64CI
BXF•
2,36CI
Land:
16,00
Market:
62 00
ssessed•
62,00
[Deferred:
Cl
Sales Information
No. Book Page Month Year Instrument Quai/UnQual Improved Price
L 01007 1069 12 2015 TD Unqualified Improved 50,000
Z 01025 0987 08 2016 WD Unqualified Improved 0
3 00188 0622 07 1996 WD Qualified Vacant 10,000
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.davie*cciuntync.gov/itsneWiew.aspx?prid=1486998 8/16/2016