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2258 Hwy 601S•. � � p.�,i+ .�R,y,.., .. ra;-.-.� x. ,:�- " ..�: r 'r ;, a �+ � Permittees D VIE COUNTY HEALTH DEPARTMENT Name: ���� �� Environmental Health Section PROPERTY INFORMATION Directions toproperty... o�S ��S r P.O. Box 848 Mocksville, NC 27028 Subdivision Name: Phone #`.336-751-8760 Section: Lot: r AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - '��AUTHORIZATION NO: S�� Z 60 Road Name: ip:- �e2 • **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv,Environmenial 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' Bu' g efts. (In compliance• with icle I f .S. Chapter13P, Wastewater Systems, Section .1900 Sewage Treatment and Disposal,Systems) ti.. f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION Ty IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMEN IST ATE SSU D RESIDENTIAL SPECIFICATION: BUILDING TYPE t J- # 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 SUPPLYC�4404N(DESIGN WASTEWATER FLOW (GPD)_ NEW SITE - REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL TRENCH WIDTH ROCK DEPTH LINEAR FT.' OTHER ` •V 1� SSThII ��(� REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 1 Nara top N14 U /1D` Ai�2��1�-� V 7 - "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 (336)751-8760. DCHD 02/02 (Revised) µ:-i � .,� �.Y} •.. � ..- t K k -l'.. � X w _ �� C Y . a+N ..=x+u�,.„.. -:. yw^.'a'b � �_,- • /let Y d 1a3 ---,4 1 ermiltee's D� ` VIE C&NTY HEALTH DEPARTMENT Name: i Y T`' Environmental Health Section PROPERTY INFORMATION r s r P.O. Box 848'. Directions to property: t' � S Mocksville, NC 27028 Subdivision Name: Y _ �• „ - 1.� _Phone #: 3-36-751-8760 o Section: Lot: AUTHORIZATION FOR WASTEWATER w Tax Office PIN:# SYSTEM CONSTRUCTION AUTHORIZATION NO:, A Road Name: Zi 2 02 3 P "NOTE*s` 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 -'e mits. (In compliance with'Alficle 11,6f,G.S. Chapter 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems) r'"� r r. ,► ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENL HEAL 1 SPECIAL IST DATE SSU D 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 1 LOT SIZE. 7 , C`TYPE WATER SUPPLY(utxr�f DESIGN WASTEWATER FLOW (GPD)� NEW SITE REPAIR SITE +� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 9 LINEAR FT. OTHER Vl SThh'!�'�i'O aA`t REQUIRED SITE MODIFICATIONS/CONDITIONS: 0' IMPROVEMENT PERMIT LAYOUT t \ r •, ��`u' !ham t: **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 (336)751-8760- 1 OPERATION PERMIT SYSTEM INSTALLED BY: t A r «3T %.9 lW 1 �w ► A� iQEtLa-j Ht3l��- AUTHORIZATION NO. 2A OPERATION PERMIT BY: DATE: ro ITS? O:;: s "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSZtQE6iCR1ABKE 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. YY` n M— --..:- pt L{rl tJt� I Jas },Lt�J� L`6 IS VS HW`f VvLJ I Il.t0tJC-_N DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER ADDRESS 7i2� SUBDIVISION NAME LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED ? NAME SYSTEM INSTALLED UNDER St„ jE1 O TYPE FACILITY I -W S -r NUMBER BEDROOMS 2 NUMBER PEOPLE SERVED Z TYPE WATER SUPPLY CV027J SPECIFY PROBLEM OCCURRING' ok—Pun) r\, (D ,c,,o S hCG 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 i COMPLAINT FORM. DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION c A /oS Date Received Name of Complainant rn-D" S ; ') o « Received By L9 -- Address 61(-. -S w o s Telephone Complaint �n �- uI�-e - �'� �5 P . mac- CL �, a n -74-4— S -ti © C,^ C?—//c, j�'-°- �� 1-� Iii► --1 -� 5:[� Person Responsible for Complaint D'"' - DQ Jt'ce M Address Telephone Directions to Complaint Date Investigated Investigated By Complaint Justified Complaint Not Justified _ Action Taken # jk16 ) & a% ` o.,4v- 9 ' r� a7rG J CALL- Rjl? Date Environmental Health Staff Signature (DCHD 1/85) A r-- G W -.,ns 4 "C) Parcel #: L510OA0009 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: L510OA0009 Account #:72156000 Owner Information Tax Codes WAIN DAVID H JR ADVLTAX - COUNTY T 135 NORMA LANE �FIREADVLTAX -FIRE TAX ADVANCE, NC 27006 Building: 28,0501 Property Information Township Land (Units/Type): 0.820 AC [Address: 2258 S US HWY 601 JERUSALEM Market: 43 75 ssessed: Deed Information Local Zoning Date: 10/1996 Book: 00110 Page: 0325 Plat Book: 0001 Page: 035 Le al Description PIN LOTS 28-30+ G P DANIEL 5746242229 Property Values Building: 28,0501 BXF: 53CI Land: 15,17 Market: 43 75 ssessed: 43 75 Deferred: Sales Information No. Book Page Month Year Instrument Qua[/UnQual Improved Price L 00110 0325 10 1996 WD Unqualified Improved 0 00112 0606 04 1984 WD Unqualified Vacant 9,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 0°v cls 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/itsnetIView.aspx?prid=1466724 7/29/2016