1257 Hwy 64W (2)DAVIE COUNTY HEALTH DEPARTMENT
Name: ,�l/�C/'t`ei 7 y Environmental Health Section PROPERTY INFORMATION
, • �- �,, ,•- l P.O. Box 848,
Directions to property.` ' i`�^''1 e -'' Mocksville NC,27028 Subdivision Name:
Phone #: 336-751-8760 Section: Lot.
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
AUTHORIZATION NO: ®a A Road Name: `�114,6ekrr, A'
(p y :Z,7�
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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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
LOT SIZE TYPE WATER SUPPLY) DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TENCH WIDTH S ROCK DEPTH LINEAR FT.S^
f r'
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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:
Y
— r
-°J
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 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.
DCHD 02/02 (Revised)
`~-- Prmif�e DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
P.O. BA 848. Y�w
Directions to property: ='" td ` lid ``f ' Mocksville NC:?7028 Subdivision Name:
Phonq#: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
f AUTHORIZATION NO: 002638 A Rod Nags 1I W ag *j 1K
**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
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE #BEDROOMS
—,F!- # BATHS _ # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) -rr NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. IIIENCH WIDTH - ROCK DEPTH f LINEAR FT. <
i '""!j /. ��t �I'p
OTHER w f rj, �, <, , 7" ZJ .
,< t
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT =
t
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:
AUTHORIZATION NO. OPERATION PERMIT BY:
ITA 0:9
**THE ISSUANCE OF THIS OPERATION PERMIT 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 NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD.OF TIME.
DCHD 02M (Revised)
• I ` j` DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
ADDRESS I7-5'7 1I!!4 (,� Wc� SUBDIVISION NAME
y1/iwlL • LOT #
DIRECTIONS TO SITE G yw - A,4- n'JAO�:.�#�" /I#"- aueZk)
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDERG�-
TYPE FACILITY /-ll�c� NUMBER BEDROOMS _-� NUMBER PEOPLE SERVED 2 -
TYPE
TYPE WATER SUPPLY YJ • - SPECIFY PROBLEM OCCURRING ur
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my know)p//, and tha understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT_d_ r�7, 4
Rev. 1/93
Parcel #:1400000002
Davie County, NC - Basic Estate Search
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Parcel #: I400000002
Account #:64996000
Owner Information
Tax Codes
HELTON BOBBY ]OE & SHELTON PAGGY O
ADVLTAX - COUNTY T
1257 US HIGHWAY 64 WEST
READVLTAX -FIRE TAX
OCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 0.630 AC
MOCKSVILLE
ddress: 1257 W US HWY 64
Deed Information
Local Zonin
Pate: 12/1969 Book: 00081 Page: 0550
Plat Book: Page:
Le al Description
PIN
1.71 AC HWY 64
5728679704
Property Values
Building:
115,0301
BXF:
01
Land:
13d74Market:
128ssessed:
128
eferred
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00081 0550 12 1969 WD Unqualified Improved 0
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
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vNY
CIOUN�
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
h4://maps.daviecountync.gov/itsnet/View.aspx?prid=1464184 7/13/2016