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AUTHORJZATION NO: Q 613: _ DAVIE COUNTY, HEALTH DEPARTMENT
" Environmental Health Section PROPERTY INFORMATION
Permittea.,s P.O. Box 848
Name".. /i C 4 P �/ Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760 1�
Directions to property: rL� �"� Sectiotfl!J.. • .r Z ; Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# '
SYSTEM CONSTRUCTION • ,/ 0/ to Road Nam 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 compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
tu IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST ', i DATE ISSUED
is
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Subdivision Name
it i t '4 r iii t
s Directions to property:r f _ Section. Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# - -
Road Name: 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
r 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)
***NOTICE*** TIIIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM. '
RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS # BATHS # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY —L!= DESIGN WASTEWATER FLOW (GPD) a y� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 'ROCK DEPTH A2 LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
?, IMPROVEMENT PERMIT LAYOUT
Y
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DAVIE COUNTY HEALTH DEPARTMENT
a ,
'�- 1 '" IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
y""
Q.
4 Permltte`C=s r _
Subdivision a
•-• ion N am • e.'
Dir;ctions to property: SectionLot:
IMPROVENWM
.f PERMrr Tax Office PIN:# - -
r ' Road Nam`e:' b d LS - Zip: AY
**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)
1 fi ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
�'� •; ,�=,s' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE_ # BEDROOMS _Cft_ # BATHS Z # OCCUPANTS_ GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE r,# PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN y� DESIGN WASTEWATER FLOW (GPD) � NEW SITE REPAIR SITE
rr
SYSTEM SPECIFICATIONS: TANK SIZE ___.L__GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH S LINEAR FT.:ZQ
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
[MP�k(,)VEMENT 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.
OPERATION PERMIT
ri
SYS7179P
AUTHORIZATION NO. — �'f OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERM? 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 NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
, APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
��
-NAME � � 0 C// PHONE NUMBER r>1,_y2'-_2/ �2
_11eil, AN
ADDRESS_All API APd%O�S' SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �/ .e NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY-_/di�, /Z SPECIFY PROBLEM OCCURRING
DATE REQUESTED /����9 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. 1/93
Parcel #: 0600000024
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Parcel #: 0600000024
Account #:6244000
Owner Information
Building:
Tax Codes
BXF•
BELL ELVIE& BELL ADDIE F
Land:
ADVLTAX - COUNTY T
Market:
016 US HIGHWAY 601 SOUTH
ssessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 2.150 AC
JERUSALEM
ddress: 4015 S US HWY 601
Deed Information
Local tonin
ate: 09/1977 Book: 00102 Page: 0894
Plat Book: Page:
Le al Description
PIN
2 AC HWY 601
5754246666
Property Values
Building:
52,71CI
BXF•
5,7501
Land:
26,29
Market:
84 75
ssessed:
84,75
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00102 0894 09 1977 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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,
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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=1471442 7/14/2016