2142 Hwy 601S• Permit(te's t lt. DAVIE COUNTY HEALTH DEPARTMENT
Name:, Environmental Health Section PROPERTY INFORMAT
P.O. Box 848
Directions to property: ��f =>� Mocksville, NC 27028 Subdivision Name:
r�Phone #: 336-751-8760
I :'L.1;.1t1T(-�%- G i ')`-� 1 Section:
AUTHORIZATION EOR
Lot:
WASTEWATER Tax Office PIN:#
r�
SYSTEM CONSTRUCTION � * �� ! R 7 1�{l �� h
AUTHORIZATION NO: 002710 A Road Name: t 1l lir C
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**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 1 I f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
r' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
�`-- "ENVIR N L �E H ECltt: ST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE``12�6G# BEDROOMS '-7—'. # BATHS # OCCUPANTS '2-- GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPE,CIIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE �'� TYPE WATER SUPPLYDESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
,I ��-j� r
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3� ROCK DEPTH � LINEAR FT. L5L
OTHER Ao-uht"> b (Jl.ID�J
REQUIRED SITE MODIFICATIONS/CONDITIONS: -r
IMPROVEMENT PERMIT LAYOUT
i Pw ►I1.rthD�S
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
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AUTHORIZATION NO.2� i A OPERATION PERMIT BY: DATE: / d�2
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS SCRIBED 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.
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Pet�itiee's „+"f DAVIE COUNTY HEALTH DEPARTMENT
t . Nairie: "<L _ ` A- l C. i 4 Environmental Health Section PROPERTY INFORMATI
/ 1 P.O. Box 848
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Directiv 'te_ploperty: f '"" ! Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
oss _ WASTEWATER
: SYSTEM CONSTRUCTION Tax Office PIN:#gg - -
AUTHORIZATION NO: 002710 A Road Name:- � l.i- (-'�� � �it �' " , -
**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 bavie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 16f G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
x r I ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
--ENVIR 6 AMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE � �A6c # BEDROOMS f # BATHS # OCCUPANTS ' GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE 1'� A TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
.e
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -Dl- ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: ^�' I" '�' rt `"' r !'Cts l� t ° C ° 401,
I
i
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT y() A jV it MI L UI
SYSTEM INSTALLED BY: RdN''►fl"t'y
i
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AUTHORIZATION NO.V7 I L44 OPERATION PERMIT B DATE: Z2
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS CRIBED ABOVE HA 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.
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,30ST PA -Sr GLOsV3 . ID : X311.1. TU
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �t�!'Vl GLIA'
AtPPLIcCATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME �� �il.t �� PHONE NUMBER
ADDRESS t Z L%S N�(aolS , )6t pG/LS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
'7
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED. UNDER
TYPE FACILITY NUMBER BEDROOMS 2— y NUMBER PEOPLE SERVED 2—
TYPE
TYPE WATER SUPPLY '�' SPECIFY PROBLEM OCCURRING ~he 01
DATE REQUESTED li hl 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
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Parcel #: L5070A0026
Davie County, NC - Basic Estate Search
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Parcel #: L5070A0026
Account #:24276000
Owner Information
uildin
Tax Codes
BXF•
ELLIS W A SR ESTATE
Land:
ADVLTAX - COUNTY T
Market:
/O FRED ELLIS
ssessed:
FIREADVLTAX - FIRE TAX
Deferred
MOCKSVILLE NC 27028
Property Information
Township
F-
Land (Units/Type): 1.560 AC
JERUSALEM
ddress: 2142 S US HWY 601
Deed Information
Local Zoning
Pate: 05/1952 Book: 00053 Page: 0459
Pat Book: 0002 Page: 084
Legal Description
- _ PIN -1
LOTS 9-24 R L FOSTER
5746153525
Property Values
uildin
70,1
BXF•
84
Land:
2205
Market:
93 07
ssessed:
93,07
Deferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00053 0459 05 1952 WD Unqualified Improved 0
View Property Record for this Parcel View Man 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/itsnettView.aspx?prid=1459570 7/19/2016