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AUTHORIZATION NO. 0855 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION .
Perim
tfee's P:O Box 848
Name: ....i P �/'d lU x,� Mocksville, NC 27028 Subdivision Name:
r Phone#: 704-634-8760
Directions to property: Section: Lot:
t AUTHORIZATION FOR
Al-t`l/.r WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION / ,,6P
Road Name: Zip:oa0 '
**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
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Pr
er #afCee .. -
game� % ^'Subdivision Name:
onslo property: �S✓ r Section: Lot:
fj �g / Jar IldPROVEMENT
PERMIT Tax Office PIN:# - -
/rill6
Road Name: 4961-!5. - 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)
P ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
%� PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER'
NMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM. � .��
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS. # BATHS -/f�=# OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT T # SEATS INDUSTRIAL WASTE: Yes or No
�/
' LOT SIZE TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW (GPD) � NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE ,&_QjLGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH f K LINEAR Fr.
j
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.
v
5
AUTHORIZATION NO. �-bPERATION 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. CHAPTER130A, 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)
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION,PERMITS PROPERTY INFORMATION
.--.„PerM11f1ee'�
t
Subdivision Name:
; ;ctiohs to'property: / r. ,: �t � Section: Lot:
' IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name: b 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
constructi6rihnstallation 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 +y '' SYSTEM ORTHE
INTENDED USE ACTOR MUST SEE THISGE. YOUR BEFORE TER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE_ #B EDROOMS # BATHS -/t:C: # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
/ V
TYPE WATER SUPPLY l°•U� /la l� IGN WASTEWATER FLOW (GPD) � NEW SITE REPAIR SITE1�
SYSTEM SPECIFICATIONS: TANK SIZE ,&L -GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Z-�� LINEAR FT. gn
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**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.
i
OPERATION PERMIT /
SYSTEM 11PTALLED BY:
D.
AUTHORIZATION NO. _``_!�-�bPERATION 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", 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) ...►*
I',-
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
r Y4'V /ePPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME r-occ�ltiN1M-o-Ar--oe--, ire ✓C•PHONE NUMBER /wS'00-55'A S�3
ADDRESS T d �o� �O� /����.,`(�/�Q$e SUBDIVISION NAME
DIRECTIONS TO SITE
LOT #
L L7
DA4 SYSTEM INSTALLED lid NAME SYSTEM INSTALLED UNDER z
TYPE FACILITY NUMBER BEDROOMS Z NUMBER PEOPLE SERVED ?
z .
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
cL / Q
7 mom, l /Z . �.�Q�cDL- . '2i o _zu A -Q--) .
DATE REQUESTED �'a� '/ IN RM Oi N
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
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
Parcel #: K516OA0017
Davie County, NC - Basic Estate Search
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Parcel #: K5160A0017
Account #: 10516000
Owner Information
Building:
Tax Codes
BXF:
BROWN BILLY JOE& BROWN LINDA W
Land:
ADVLTAX - COUNTY T
Market:
PO BOX 441
ssessed:
FIREADVLTAX - FIRE TAX
eferred•
MOCKSVILLE NC 27028
Property Information
Township
FLand (Units/Type): 2.350 AC
JERUSALEM
dress: 1746 S US HWY 601
Deed Information
Local Zoning
Date: 02/1982 Book: 00115 Page: 0655
lat Book: 0001 Page: 097
Le al Description
PIN
LOTS 73-78 R P ANDERSON
5747007747
Property Values
Building:
91,9501
BXF:
3201
Land:
26,57
Market:
118 84
ssessed:
118,84
eferred•
Sates Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00115 0655 02 1982 WD Unqualified— Improved 0
View Property Record for this Parcel View Mao 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.daviecountync.gov/itsnet/View.aspx?prid=1474623 7/14/2016