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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
° **NOTE** This i4royement 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 r r9i PROPERTY ADDRESS DATE 1/7;
/ o,eof —v/ v .a
LOCATION r_, �,t/L.1 D//I •
SUBDIVISION NAME LOT NUMBER SEC /BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS �'� # BATHS .2 # OCCUPANTS ' GARBAGE D60SAL: Yes
4
COMMERCIAL SPECIFICATION: FACILITY TYPE�.' # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
',�
LOT SIZE TYPE WATER SUPPLY < D DESIGN WASTEWATER FLOW (GPD) 0' "NEW SITE, �s• ''.. REPAIR SITE _L:tf'
SYSTEM SPECIFICATIONS: TANK SIIE GAL. PUMP TANK GAL.g TRENCH WIDTH ROCK DEPTH : LINEAR FT. /.J-0
OTHER .
nrrtilrnCn nl-rr unnrc*rnT\rrle�m►mttrnue.
:IfYJI{GY OJ IG r1YYJrJMiJV1WI WIWJIJVI\J.
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE*NANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MAST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
1 -
a
�S E�tY
IMPROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
v,•;,
AUTHORIZATION N0. Q>0 OPERATION PERMIT BY �. DATE
**THE ISSUANCE OF THIS'OPERATION PERMIT SHALL INDICATE,THAT'THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE;;WITH
ARTICLE.II 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.
rJ
DCHD 10/95
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
;`.IMPROVEMENT PERMIT��
*ATE*+'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. owk
' (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME �1� %/� �i�r /i^,✓' PROPERTY ADDRESS � �"" n ^, ri -. DATE G / 1'7 j
• it �i?r Cy£�-rte/ t el- l
LOCATION
SUBDIVISION NAME OT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE ✓ , t # BEDROOMS # BATHS - # OCCUPANTS "� � GARBAGE DtS : Yeses,
COMMERCIAL SPECIFICATION: FACILITY TYPE ` # PEOPLE #.,PEOPLESISHyIFT # SEATS INDUSTRIAL WASTE: Yes/No
`- REPAIR SITE
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW {BP� : SITE*
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH _/ ROCK DEPTH - LINEAR FT.
,.:.. s OTHER
REOUIRED,SITE.MODIFIEATIONS/CONDITIONS:
Is PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE S. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
• ,_ ., ' 1 �} ' ' ` X44 '
EV F -y
! IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF*)DAVIE COUNTY-REjLTH 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 rte+.Sh�
AUTHORIZATION NO. C7 O OPERATION PERMIT BY + �. DATE
**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' I BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY.GIVEN PERIOD OF TIMEA''. �~+
DCHD 10/95 -�
.'rr rwS-'1 ;-. ^c •.'ti; t h.. Yl. "p. l�, i1 i.l r-.�{t fr. i ri :ti'^, _..,..
-
.
' Davie County Health.Departeent J 00
ENVIRONMENTAL HEALTH SECTION
P.O. Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CWSTRUCTIW
(Issued in colpliance with Article ll of
G.S. Chapter 130A, Wastewater Systems)
***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.***
JS.•�/ J/Iely/DATE ✓ �I%~"/7 -'�� AUTHORIZATION NUMBER
NAME N _ ' j 02 2
NAME ON IMPROUM9 PERMIT (If different than above)
SITE LOCATION
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
*HWICE*#* THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONENTAL SPECIALIST DATE
DCHD 10/95
4
`/ DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
. 111-! /j61�leP:LIOATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME C� PHONE NUMBER
ADDRESS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED �-
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED -/ INFORMATION TAKEN BY
This is to certify that the Information provided is correct to the best of my knowledge, and th I nderstand I am respons21bleall charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENTr
Rev. 1193 ,
Parcel #: E300000105
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 #:E300000105 Account #:64988000
Owner Information
uildin :
I ax Codes
BXF•
HELTON BILLY R
Land:
I IC ADVLTAX - COUNTY TA
arket:
190 US HIGHWAY 601 NORTH
essed:
IFIREADVLTAX - FIRE TAX
Deferred
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 0.930 AC
CLARKSVILLE
ddress: 3190 N US HWY 601
Deed Information
Local Zoning
Pate: 05/1966 Book: 00076 Page: 0055
Plat Book: Page:
Legal Description
PIN
1 AC HWY 601
5821022664
Property Values
uildin :
109,9 2
BXF•
1321
Land:
1896
arket:
142,09
essed:
14209
Deferred
Sales Information
No. Book
Page Month Year Instrument
Qual/UnQual
Improved Price
1 00076
0055 05 1966 WD
Unqualified
Improved 0
View Property
Record for this Parcel View Map for
this Parcel View
Tax BIII 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/itsnetfView.aspx?prid=1464183 8/24/2016