1064 Hwy 801NAUTHORJzAT1oN NO:- 1195,
DAVIE COUNTY HEALTH DEPARTMENT .
- Environmental Health Section PROPERTY INFORMATION
Permtttee's P.O: Box 848
Mocksville; NC 27028 Subdivision Name:
Phone # 704-634-8760
i Directions to property: Section: Lot:
AUTHORIZATION FOR
p,.. WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION ' j� � �} • ._ �a � a� � D�
Road Name: Zip: C
**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 1 l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/ "�z IS VALID FOR A PERIOD OF FIVE YEARS.
EN RONMENTAL HEALTH SPECIALIST DATE ISSUED
� "yam ... � �'�_�+'�i++.4y:r y,� •,,,.r §+�� �: sem. vv �,,.... �,�--5._.tr � .. . ._ �- r Irv`*
19 5 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Directions to property:
A� - �y Y
E%IPROVEMENT
PERMIT
Subdivision Name:
Section: Lot:
Tax Office PIN:# - -
/0 6 1/
Road Name: a 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
construction/msfallation 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)
'0 %f �'' ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
lea
° 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/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY c/ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH CSL LINEAR FT. �/
OTHER
"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) 6348760.
OPERATION PERMIT _ /,! J
SYSTEM INSTALLED BY: 00
v
1� J �l
AUTHORIZATION NO. � OPERATION PERMIT BY: GY� 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 05/96 (Revised)
r1
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
,Permite's,
�.
"'N ies 'jo{:t 1.0ho '' Subdivision Name:
41 . Directions to property: r' ''` Section: Lot:
zq IMPROVEMENT
PERMIT
• u Tax Office PIN:# - -
Road Name: 0 Zip: 4 16 '01(;
**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
constructiorAmstallation 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*** THIS 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 IF # BATHS :V— # OCCUPANTS O[ GARBAGE DISPOSAL: Yes or No
s
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFf / # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY ' L DESIGN WASTEWATER FLOW (GPD) Y�-'10 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. , TRENCH WIDTH 3` ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS;
IMPROVEMENT 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
SYSTEM INSTALLED BY:
/
A�I)K�
HOg�'p�TION NO. OPERATION PERMIT BY: DATE:
**THE ISSU 11 CE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICL 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE , AT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
A
; .
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
,Permite's,
�.
"'N ies 'jo{:t 1.0ho '' Subdivision Name:
41 . Directions to property: r' ''` Section: Lot:
zq IMPROVEMENT
PERMIT
• u Tax Office PIN:# - -
Road Name: 0 Zip: 4 16 '01(;
**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
constructiorAmstallation 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*** THIS 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 IF # BATHS :V— # OCCUPANTS O[ GARBAGE DISPOSAL: Yes or No
s
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFf / # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY ' L DESIGN WASTEWATER FLOW (GPD) Y�-'10 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. , TRENCH WIDTH 3` ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS;
IMPROVEMENT 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
SYSTEM INSTALLED BY:
/
A�I)K�
HOg�'p�TION NO. OPERATION PERMIT BY: DATE:
**THE ISSU 11 CE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICL 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE , AT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
A
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME'r%ow��iav C^'t`=w F �„uo. PHONE NUMBER 334- 9(//- vlgt
ADDRESS - Lit, ?Lu.r-f= L.a yt Ad t). 27ooG SUBDIVISION NAME
/A Po'l r" "e -o" = u d -
w " L k
•(ir.,'61 � n[c.d
% n W Fr.-� y d i
LOT #
DIRECTIONS TO SITE IST-
T.
L., -F+ R.,Jlam
.9
Rd- Sco 1-'r. 4,P I-
- I. "b kms. o� R-�- b-e,S .vim•
,.,I yY,-o,',1 61(- 4)
DATE SYSTEM INSTALLED ol'c..Q NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �j — NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED 3
TYPE WATER SUPPLYSPECIFY PROBLEM OCCURRING Ca,, nai- PI -,1,
)DAtItS It, h k
DATE REQUESTED Z - 3 —`1 Q- 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
Parcel #: C70000002601
Davie County, NC - Basic Estate Search
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Parcel #: C70000002601 Account #:73270000
Owner Information
Tax Codes
ADVLTAX - COUNTY T
FIREADVLTAX - FIRE TAX
HOMPSON JUDY ELLIS
it ORCHARD PARK DRIVE
ERMUDA RUN NC 27006
BXR
19
Property Information
Township
Land (Units/Type): 1.300 AC
ddress: 1064 N NC HWY 801
FARMINGTON
ssessed:
10335
eferred•
Deed Information
Local Zoning
Pate: 12/1997 Book: 00199 Page: 0089
Plat Book: Page:
Le al Description
PIN
1.43 AC HWY 801
5862277912
Property Values
uiidin
66,56
BXR
19
Land:
3660
arket:
10335
ssessed:
10335
eferred•
Sales Information
No. Book Page Month Year Instrument Quai/UnQual Improved Price
L 00199 0089 12 1997 WD Unqualified Improved 63,000
Z 00155 0312 07 1990 WD Qualified Improved 70,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnet/View.aspx?prid=1464979 9/15/2016