2105 Hwy 64W Permittee' E Cp NT H DEPARTMENT
l�ramei r..X ! rn I et t th Section PROPERTY INFORMATION
1�5� �r/,: .�tJhJ Box 848
Directions to property. t ! Mocksville,NC 27028 Subdivision Name:
Phone#:336-751-8760
Section: Lot:
AUTHORIZATION,FOR.
WASTEWATER
l Tax Office PIN:# _
®® SYSTEM CONSTRUCTION
AUTHORIZATION NO: A 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 compliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
r k ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEllROOMS #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 PG DESIGN WASTEWATER FLOW(GPD),z� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS:.TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT:ZT-V
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
E:::J
,�✓ ctl
y i�0. llolll wh,
**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.
OPERATION PERMIT
SYSTEM IN BY: �✓`
.; ..> L-t
-
01
AUTHORIZATION NO.ca OPERATION PERMIT BY: DATE:
77
**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 SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
ncHn ozroz(Revised)
i
Pernuttee's6 jrA�V`I�QONTY H�+t T�� DEPARTMENT
DtaiYie'." ,did filth SectionPROPERTY INFORMATION
;�, ,a _ J I ✓" Box 848
�Direcuons t property. r y ,r'i'yy;= e r ` ,�t/� Mocksville,NC 27028 j . 'Subdivision Name:
Phone#:336-751-8760 f
f Section: Lot:
AUTHORIZATION FOR
It'll" � "�� rt f < ,'1r /r ;' f� WASTEWATER Tax Office PIN:# -
SYSTEM CONSTRUCTION '
.AUTHORIZATION NO: 4,008 A Road Name: Zip:
**NOTE**°This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Envii-onmental Health Section prior
,w- 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)
f r ***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 #PEOPLFJSHIFT ( #SEATS INDUSTRIAL WASTE:Yes or No .'
LOT SIZE TYPE WATER SUPPLY (DESIGN WASTEWATER FLOW(GPD)s—� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH / V LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
S� Av
r
v
t y
-*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.
OPERATION PERMIT
SYSTEM INSTALLED BY:
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'brHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 0=(Revised
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
• APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME G PHONE NUMBER
ADDRESS -S SUBDIVISION NAME
LOT#
DIRECTIONS TO SITE (e Lj M • _J a- -s
ao=44-
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER '
TYPE FACILITY NUMBER BEDROOMS c;'-- NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
0'NI", �[d- a SSC-rfLyy Sit ��`^ro
DATE REQUESTED -3 INFORMATION TAKEN BY L�
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
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) �
NAME >Z¢ Rio PHONE NUMBER 14--
ADbRESS Z-( a S' t,��c C� `f w SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE ` 44O
a,J I�.Q C/10� cam+-. c c_
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER S � ,
TYPE FACILITY NUMBER BEDROOMS c;)N NUMBER PEOPLE SERVED / 0 rL
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED ` b 7� INFORMATION TAKEN BY lQ-
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#: H300000056 Page 1 of 1
rN.V7�
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Parcel#: H300000056 Account#: 12480000
Owner Information Tax Codes
MPBELL CONNIE MAE Y ADVLTAX-COUNTY TAXI
16 MCDANIEL ROAD FIREADVLTAX-FIRE TAX
DVANCE NC 27006
PropertV Information Township
nd(Units/Type): 0.610 CALAHALN
[Address: 2105 W US HWY 64
Deed Information Local Zoning
ate: 10/1985 Book: 00129 Page: 0256
Plat Book: Page:
Le al Description PIN
WY 64 12480000
Property Values
uildin 43,55
BXF•
nd: 2500
Market* 6855
ssessed• 68 55
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00128 0093 09 1985 WD Unqualified Improved 12,000
00129 0256 10 1985 WD Unqualified Improved 22,500
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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,
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=1460019 7/5/2016