2180 Hwy 601S (2)y Av h Y , id \•!tw if .f.- f _. � nl .. f:.-.� .. r .:. t-- r .r.
Permittee's i AVIE COUNTY HEALTH DEPARTMENT
" / ' ,r j r ; T3 Environmental Health Section PROPER Y INFORMATION
Name'
- � t•.r �� ,, i P.O. Box 848 ,
rDirections to property: J Mocksville, NC 27028 Subdivision Name:
Phone #• 336-751-8760
Section: Lot:
/ AUTHORIZATION FOR
WASTEWATER
r` o, r,rry fEr T° ! { %�{1J" r:+✓� Tax Office PIN:# - -
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 9120 A 1` Road Name: Zip:
**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 cotrlpliance with Article 11. of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
All,.t/ r ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
EN IRONMENT,4L HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS —J— # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY 0n DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
J�
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. .TRENCH WIDTH_ ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
}
"*CONTACT A REPRESENTATIVE OFTHE 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 (336)751-8760.
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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 SATISFAC'T'ORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102 (P -i -d)
'DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME 7DO n a,l of7 L Qn,- C -C- PHONE NUMBER D�-b
(.1 P-t-`� (�, ° 1 S "* SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
6-7
6j
DATE SYSTEM INSTALLED IX !r" S NAME SYSTEM INSTALLED UNDER LC4a'elq
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED g
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING `-•
DATE REQUESTED k2--/3 0 JO -,- 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 C• q4) Vl)*r�v5 �, 7
Rev. 1193
Parcel #: L510OA0031
Davie County, NC - Basic Estate Search
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Parcel #: L510OA0031
Account #:78114000
Owner Information
uildin
Tax Codes
BXF•
HITAKER MICHAEL R& WHITAKER JOYCE A
Land:
ADVLTAX - COUNTY T
arket:
162 COUNTRY LANE
ssessed:
READVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
00705 0649 03 2007 WD
Qualified
Property Information
Township
nd (Units/Type): 1.180 AC
JERUSALEM
ddress: 2180 S US HWY 601
Deed Information
Local Zoning
Date: 03/2007 Book: 00705 Page: 0649
Plat Book: Page:
Le al Description
PIN
1.35 AC HWY 601
5746144934
Property Values
uildin
35,39
BXF•
248
Land:
1805
arket:
55,92
ssessed:
55,92
Deferred:
3
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved Price
1
00191 0722 12 1996 WD
Unqualified
Improved 0
2
00431 0681 08 2002 WD
Unqualified
Improved 0
3
00705 0649 03 2007 WD
Qualified
Improved 58,000
View Property Record for this Parcel View Map 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/itsneWiew.aspx?prid=1466002 7/19/2016