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AUTHORIZATION NO: 0973", DAVIE COUNTY HEALTH DEPARTMENT
` Environmental Health Section PROPERTY INFORMATION
Permittee's /� .�L /� P.O. Box 848
Name: Mocksville, NC 27028 Subdivision Name:
�) Phone k 704-634-8760 .
Directions to property: ::&'at� /U Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION �iaa0 -
1
Road Name: Zip: �(IyOti
**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 Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
!' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
aq }., Mc rr.�, y�rY�{�y n"l lF,fs�:a r <�,,,.:":..y_w, v�''C4`x�..'�1•'by,:.: %,r.Y`�.e• 'f=;} �,'r;_ r.. ,.. n :-�:.r •ir
t ✓: ..�.%'�+, ''. „'" r r it :;�x' r „};, rya"' �+ �".rv=w3}`,,w, }' i,�.>i _O
"f X=r DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Subdivision Name:
irections to property:"`/`�G 'i r1f�' Section: Lot:
} IMPROVEMENT
PERMIT Tax Office. PIN:# _
Road Name Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic 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)
f,, ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
4
l :.� . `if r`e� 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 /V// # BEDROOMS —,2_—# BATHS —4:`# OCCUPANTS �J GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE Zi GAL. PUMP TANK GAL., TRENCH WIDTH -?lr� I ROCK DEPTH LINEAR FT. �
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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:
f /I
T°
Q l^
AUTHORIZATION NO. t J OPERATION PERMIT BY: C�c Cea 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", BUT SHALL IN NO WAY BE AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. -
ra 4 g.a�i.- �HY;.•Y (; rt ,,�y„�,� �„ $-...--: 'Y ::. _''9a`+ Y'% 'i z "'`r I-�,y::� ":y, f"ta: T .s..•. _rr v _ -
=%= DAME COUNTY HEALTH'DEPARTMENT '
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
�.
Pemuf#ee'- i
Subdivision Name:
It?irections to property: " '� +,'� r�` - >' ! �'" t`r �' Section Lot:
IMPROVEMENT
PERMIT Tax Office PIN -1.
r �
Rdadame: �� 0 1 N. Zip: A
**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)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
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 t} # BEDROOMS ,^ # BATHS # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE ' # PEOPLE/SHIFr-,% `*,- # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE - REPAIR SITE +' b
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH -le LINEAR
%. *OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
r ,
"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.
OPERATION PERMIT
-' SYSTEM INSTALLED BY:
I N3
U �,•
a.
it
tit .y
t i,,
AUTHORIZATION NO. CO3 OPERATION PERMIT BY DATE: _ 9�
"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)'
s _.
S
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
/ %/WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME _!/��✓ �` X le'a 2 e PHONE NUMBER
ADDRESS SUBDIVISION NAME
/J SUBDIVISION LOOT #.
DIRECTIONS TO SITE C IfSS r �e�c ��isd ,�i��`c, A/41e
ol
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN BY z'400�
Parcel #: C300000046
Davie County, NC - Basic Estate Search
B'Asic Search Real Estate Search Tax Bill Search Sales Search
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #:C300000046 Account #:8300470
Owner Information
uildin
Tax Codes
BXF:
LKINS DEBRA B & WILKINS TERRY LEE
E52ADKINVILLE,
nd:
ADVLTAX -COUNTY T
arket:
WEST LEE AVENUE
ssessed:
READVLTAX - FIRE TAXNC
Deferred
27055
Property Information
Township
Land (Units/Type): 0.830 AC
CLARKSVILLE
ddre ss:: 4620 N US HWY 601
Deed Information
Local Zoning
Pate: 07/2011 Book: 00863 Page: 0575
Plat Book: Page:
Le al Description
PIN
10.827 AC OFF HWY 601 N
5823117993
Property Values
uildin
BXF:
9101
000111
nd:
7,96
arket:
16,97
ssessed:
16 97
Deferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00142 0083 02 1988 WD Unqualified Improved 0
? 00863 0575 07 2011 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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�D U t4'�
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=1471491 8/9/2016