2347 Hwy 601Srrw"�4 d.., a '-.s• .;y;s < „ - ¢ t -ani"... ` r • . ' 5b ;ti ^'F .-1.{,.jl :lay ...:. i 3'. .. % F
;4. t DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOfE:.Issued_in Compliance with G.S. of North Carolina Chapter 130 Article. 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Per it Number
Name 74c,/`frs'; i•,^ i� Date, N.21w
Loca
AZ
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home �� Business - Speculation
No. Bedrooms 3 No. Baths ;2 No. in Family _
Garbage Disposal YES p NO 1'"
Specifications for�System:
Auto Dish Washer YES NO
Auto Wash Machine YES NO p flaX3 X
Type Water Supply < n
*This permit Void if sewagesystem described below is not installed wy is-36-rn th from date of issue.
4*1
i
Improvements permit by
*Contact a representative of the Davie County Health Department for final ' spection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion,_ Telephone Number- 04 34-5985.
FinalInstallationDiagram: System stalled bZa
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with r
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone-�'��`'J
1. Permit Requested By Business Phone
2. Address _ 106 01,0 e s -Iv.- 6r'r -.4V C 07 b2�
3. Property Owner if Different than AboveA7,�9 6-,
Address �'2? / 6� 'o -e -D ,se� '/ �!q
4. Permit To: a) Install Iter Repair
b) Privy Conventional her Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home_h=:_-_-"B'usiness
IndustryOther
b) Number of people R
6. a} If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms 3 Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes 1Z
lavatory
L
urinals
showers
dishwasherT sinks
8. a) Type water supply: Public kl- Private Community
b) Has the water supply system been approved? Yes —L--No-
9.
--No
9. a) Property Dimensions
b) Land area designated to building site / I-L_
c) Sewage Disposal Contractor
garbage disposal
washing machine
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
. 3 - - Z_ F-!� Q'i� , d'__. "A�
47
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
Parcel #: L5100B0018
Davie County, NC Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
View Prooerty Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: L5100B0018
Account #: 8300030
Owner Information
BXF:
Tax Codes
Land:
HOLCOMB ALAN E
Market:
ADVLTAX - COUNTY TA
ssessed:
449 GREENWICH ROAD
Deferred
FIREADVLTAX -FIRE TAX
1 00848 0903
INSTON-SALEM NC 27104
2011 WD
Unqualified
Property Information
1 00173 0364
Township
FLand (Units/Type): 5.280 AC
Qualified
JERUSALEM
dress: 2347 S US HWY 601
Deed Information
Local tonin
ate: 01/2011 Book: 00848 Page: 0903
Plat Book: Page:
Le al Description
. PIN
16.400 AC HWY 601
5746334819
Propertv Values
Buildin :
65,3301
BXF:
01
Land:
46,39
Market:
111 72
ssessed:
11172
Deferred
Improved 0
Sales Information
No. Book Page Month Year Instrument
Qual/Ungual
Improved Price
. 00350 0246
10
2000 WD
Unqualified
Improved 0
! 00566 0117
08
2004 WD
Unqualified
Improved 0
1 00848 0903
01
2011 WD
Unqualified
Improved 0
1 00173 0364
02
1994 WD
Qualified
Improved 50,000
View Properly Record for this Parcel View Map for this Parcel View Tax Bill Information
« Return to Basic Search
Page 1 of 1
.
r,
00
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=1460776 1 7/29/2016