2578 Hwy 601N' D"IE COUNTY HEALTH DEPARTMENT'
y
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
-Sewage Treatment d Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number',
Name Date % �> A �,� -S
Location
00 Ig as #Wy 4Z Vi le,'
Subdivision Name Lot No. Sec. or.BlockrNo.
Lot Size %` House Mobile Home_ Business Speculation
No. Bedrooms �" No. Baths __%!=? No. in Family --2—
Garbage Disposal YES ❑ NO ❑ Spe is fications_%f rSystem: ,
Auto Dish Washer YES E]NO ❑
Auto Wash Machine YES] NO '❑
Type Water Supply
*This permit Void if sewage system described below is not irist2lled ` ithin 36 months from date of issue.
t fLA
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 by
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. y"
APPLICATION -FOR SITE EVALUATION/IMPROVEMENTS PERMIT�
1b
Davie County Health Department '
Environmental Health Sectionr
• R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
ban be re abed cry
Home Phone Ane_(�8q .X&V eiA_-r y60R
1. Permit Requested By159'an�'� �� �►'en - _- Business Phone
2. Address. J6 & &_, )k 17-00leemee. IM ?-701y
3. Property Owner if Different than Above La4AII�04 n
Addressgum= 5'
4. Permit To: a) lnstall 'f!� Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions —"Ti Ai Q8J9"i 419,
Bed Rooms— Bath Rooms 3- Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes urinals garbage disposal
lavatory showers washing machine
dishwasher ) sinks
8. a) Type water supply: Public Private_ Community 1-� WV21CC'ded V{w--en wd( d-
b) Has the water supply system been approved? Yes Nom�� wed
9. a) Property Dimensions—2 A-e._/Z eS
b) Land area designated to building site
c) Sewage Disposal Contractor T�yi-q "Naar,nrrj
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? /*
What type?
This is to certify that the information is correct to the best of my knowledge.
Date Omtgr Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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Coo l QW6U/y D n rC�(J, t� 1 Qi 1U5G Jvl� COC d 4UfnS �3e5 i e1 e..
n� S �,; ek,t T -o l l oui I oSe i'x) road as i4 b ears 1 e f -i- 44 ,,,au S 1,
woods , lkt se_ 51' k. I's l a c LI -cd oIn [1 k, [,'l -6 Y1 � k+ a P (-a c -ed.
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DCHD (6-82)
kc,ve o`1
'-fi,'e Karen
b45 Q�ocl�-� CtkiYec� � nS
w or k, (0 3 q- 3 Sq 3. o r (o 3
>c�
. Parcel #: F30000010103
Davie County, NC - Basic Estate Search
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View Prooerty Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: F30000010103
Account #:18936000
Owner Information
Tax Codes
REASON TERRY RAY& CREASON KAREN DIANE SHORE
ADVLTAX - COUNTY TAX
578 US HIGHWAY 601 NORTH
READVLTAX - FIRE TAX
MOCKSVILLE NC 27028
225 98
Property Information
Township
Land (Units/Type): 7.160
CLARKSVILLE
ddress: 2578 N US HWY 601
Deed Information
Local Zonin
Pate: 05/1985 Book: 00126 Page: 0766
Plat Book: Pa e:
Le al Description
PIN
7.16 AC HWY 601
18936000
Property Values
Building:
155,45
BXF:
2,590
Land:
67,940
Market:
225 98
ssessed:
179,8701
[Deferred:
46 li
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00126 0766 05 1985 WD Unqualified Vacant 0
View Prooerty Record for this Parcel View Mao for this Parcel View Tax Bill Information
r< Return to Basic Search
Page 1 of 1
o�' Mrs
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=1469467 8/10/2016