4228 Hwy 801N/ ".. .) f '.o 1 �,y 4,.r ';.10+. p;�. ., p?�- �, = r .* { ., _ d a Y .:e � T .� 4 ',.1 �., • ,':.',
Permit tee's ,� � DAVIE COUNTY HEALTH DEPARTMENT
Name: / /,/o a 4A Environmental Health Section PROPERTY INFORMATIO
P.O. Box 848
Directions to property: Mocksville, NC 27028 Subdivision Name:
k�',; ;'?✓' " / ">J .�',�� •�' :': �. < : <. Phone # 336-751-8760
1 Section: Lot: /.
AUTHORIZATION FOR
/• �',•i�i;t ;t^' Y {.w ta4
2157
WASTEWATER Tax Office PIN:# -
� SYSTEM CONSTRUCTION
" AUTHORIZATION NO: A Road Name: d �l /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 l l 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 h # BEDROOMS # BATHS. # OCCUPANTS GARBAGE DISPOSAL: Yes or No '
COMMERCIAL SPECIFICATION: FACILITY TYPE% # PEOPLE # PEOPLE/SHIFT # SEATSINDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �r%t/ NEW SITE - REPAIR SITE _110000/
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FTs
OTHER �ss /� ell
REQUIRED SITE MODIFICATIONS/CON
DITIONS:
UI
*'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.
ge. 0Z
OPERATION PERMIT
SYSTEM INSTALLED BY:
- U
r
AUTHORIZATION N �/ 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.
6
DCHD 02102 (Revised) '-4'
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
DIRECTIONS TO
UBDIVISION NAME
.�� 1/• Il _ LOT #
0
DATE SYSTEM INSTALLED o NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS & NUMBER PEOPLE SERVED
TYPE WATER SUPPLY l SPECIFY PROBLEM OCCURRING
DATE REQUESTED 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 #: B300000077
Davie County, NC - Basic Estate Search
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Parcel #: B300000077
Account #:29902000
Information
Building:
Tax Codes
BXF•
E220Owner
UGH BUDDY DALE
Land:
ADVLTAX - COUNTY YT
Market:
NC HIGHWAY 801 NORTH
ssessed:
FIREADVLTAX - FIRE TAXOCKSVILLE
Deferred:
NC 27028
Property Information
Township
(Units/Type): 12.600 AC
Ess:
CLARKSVILLE
4228 N NC HWY 801
Deed Information
Local Zoning
ate: 01/2001 Book: 00356 Page: 0089
[Plat Book: Page:
Le al Description
PIN
12.00 AC HWY 801
5823565496
Property Values
Building:
117,1201
BXF•
2,2801
Land:
111,10
Market:
230 50
ssessed:
230,50
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00356 0089 01 2001 WD Unqualified Improved 0
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/itsneWiew.aspx?prid=1478167 9/8/2016