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-�1,UTFft�RIZATION NC?: • � � � DAVIE�COU�TY�HEALTH DEPARTMENT `
, .; ° Env ronmental Health Section -, PROPERTY 'INFORMATION ' �
Permittee's � ' ��, ' , P.O. Box 848 � ;
Name: � ' ��./iij°�' � ���"/LG��a /� � Mocksville, NC 27028 Subdivision Name: �
` � ' ���-'. ' Phoc�e # 336-751-8760 `
� ions to property:` ,. '�. Section: Lot:
. � / /, ° ,AUTHORIZATION FOR �
Direct
. '
/�j'�11�./f •,�'��%r�_",. : ��/ � ' WASTEWATER � Tax Offi�e PIN:# _
, � . ,: SYSTF,M:CONSTRUCTION. . ` .
� t � Road Name: Zip;
**NOT'E** This Authorization for Wastewater System Consuuction MUST BE ISSUED by the Davie Counry Environmental Health Section prior
` , t� issuance of any,Building�Pernuts: This Forni/Authorization Number should be presented to the Davie Counry Building Inspections, .:"
J ; Office when applying for'Building Permits: - '
•; (in compliance'with Article 11 of G.S.' Chapter'130A, Wastewatec Systems, Section :1900 Sewage Treatment and Disposal Systems) .
�,,
�- '�' (/ � � /"� ' ' �.., ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
, ,
� .'i A \' . �,,�!�� � � . .' . . .
i /�-�r ... �`"1,{ - ��:-� i' �''%/' ;, IS VALID FOR A PERIOD OF FIVE YEARS.
,
NVIRONIVI�NTAL HEALTH SPECIALIST �, DATE 1SSUED .
. . ._ . . _'�, , .. , .._.. ' .. j _. . _ � . . -. . .. .. ,
1, t V-'1% v °
NAM
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION /0
APPLICATION FOR IMPROVEMENT PERMIT REPAIR 7
y PHONE NUMBER
BDIVISION NAME
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 that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT,
Rev. 1193
r /"�*rrou, »-rr .. ' :'.`+„ u..w r, .r }�., t> rs aF' Y• h -i+- _ , � „_. s
0
t44:
DAVIE COUNTY HEALTH DEPARTMENT
a - IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMKtION
erm�ee s f '
` `NaiieI''�J'�- I',;Gf� ,r"? Subdivision Name:
r:Directions to property�1_�"�� a'?F t/� Section: Lot:
IMPROVEMENT .
r, r` PERMIT: Tax Office PIN:# t'
'*
Road Name: Zip: ' $
**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)
r
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
` PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM:
RESIDENTIAL SPECIFICATION: BUILDING TYPE_ ,� # BEDROOMS _ # BATHS / # OCCUPANTS `'' _ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE ` # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE 4
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH G ROCK DEPTH 0 LINEAR FT. .
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**THE ISSUANCE OF_THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
Parcel #: KS 10OA0034
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Parcel #: K5100A0034
Account #:82514275
Owner Information
Building.,
Tax Codes
BXF:
ONES STEVEN G
Land.,
ADVLTAX - COUNTY T
Market.,
O BOX 361
Unqualified
FIREADVLTAX - FIRE TAX
Deferred,
OOLEEMEE NC 27014
00317 0215
10
Property Information
Unqualified
Township
nd (Units/Type): 0.680 AC
3
JERUSALEM
[Address: 1739 S US HWY 601
1984 WD
Qualified
Deed Information
6,000
Local Zoning
Pate: 01/2000 Book: 00322 Page: 0868
01
2000 WD
Plat Book: 0001 Page: 097
Improved
57,000
Le al Description
PIN
OTS 25-26 R P ANDERSON
5747100891
Property Values
Building.,
6d83
BXF:
Land.,
1
Market.,
8ssessed:
Unqualified
8
Deferred,
z
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved
Price
1
00124 0285
09
1984 WD
Unqualified
Improved
6,000
z
00317 0215
10
1999 WD
Unqualified
Improved
34,000
3
00114 0285
09
1984 WD
Qualified
Improved
6,000
4
00322 0868
01
2000 WD
Qualified
Improved
57,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
tion
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01-orivi-S
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=1459355 7/19/2016