4242 Hwy 801N. � M lit
�. Pqrtec's, , DAVIE COUNTY HEALTH DEPARTMENT
Name: ,.*�,� r f.�',✓ Environmental Health Section PROPERTY- INFORMATION
t P.O. Box 848:
Directions to property:�r`%f�. i. , `�%1,! Mocksville, NC 27028 Subdivision Name:
w"
Phone#: 336-751-8760
%`}�'/✓, : t'�t Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
AUTHORIZATION NO: A ' Road Name: Zip:
**NOTE** This Authorization for Wastewater System Construction MUST B 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 .1400 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMEN AL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 1 / # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT j} # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY U DESIGN WASTEWATER FLOW (GPD), !d NEW,SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �✓ LINEAR FT. s 0
"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 1� .�A/ / /J./.✓� ilii
F
yS �w
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 O2N2 (Revised)
-DAVIE COUNTY HEALTH DEPARTMENT
- (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR C ` -,, DATE - ,.t- 1 1 PERMIT
LOCATION ,1 �•S - .�;.r��,t_ ..t cr1 - �,{.-,t�-cr chJr7l , 7C `a:� J lr*(16. - N? 1500
" _ _ S R
SUBDIVISION NAME ,,` LOT NO.
`r 3:
N0
SECTION OR BLOCK NO.
HOUSE 'MOBILE HOME U BUSINESS ❑
House Trailer 800 Gal. . 400 Sq. Ft.
NO. BEDROOMS . NO. BATHROOMS ` Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES (D' NO [3Four Bedroom House 1000 Gal. •1200 Sq. Ft.
AUTO..WASH. MACHINE YES ®' NO ❑ p r / � � �a 1 �i CAS
SITE SUITABLE YES [3 NO [3f�`,•
SIZE OF TANK gal.. S X ly.koa
NITRIFICATION FEi;) —f /�i sq. ft.
DEPTH OF STONE IN LINES: "Ievcc
WATER SUPPLY: Individual ❑ ' Public, ❑
IMPROVEMENTS PERMIT BY INSTALLED BY r _
1 (•r_�
CERTIFICATE OF COMPLETION
By -- Date _
(8/16/73) *Construction mustycAAglyi other applicable State and loca ons
LOT AREA
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a• -Ca
1 I'
is
CERTIFICATE OF COMPLETION
By -- Date _
(8/16/73) *Construction mustycAAglyi other applicable State and loca ons
LOT AREA
w
a• -Ca
1 I'
is
DAVIE COUNTY HEALTH DEPARTMENT V
P. 0. BOX 57
i MOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAMERN`i"r.nleti' DATE ISSUED�-7i
ADDRESS�,trnr� t�;',�c�e„s� PERMIT NO. -7e \
Explanation of charge J•ln��R��en+e►v.Qr�.3 p
AMOUNT DUE `%5.� SANITARIAN `1
PLEASE REMIT THE ABOVE AIIOU14T ON RECEIPT OF THIS STATEMENT.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION -7.
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME j rn
`!� 1 X)L_41_- PHONE NUMBER
ADDRESS �-J - A)L2! �- Y �CUl A) SUBDIVISION NAME
e-- LOT #
DIRECTIONS TO SITE Leel /J Q Cor tj"— P2 �� s ce�ylxc
/-S G l/4 Qy ass's �/ e r�-o n��c e� /e� . .• c��i.r:� sc� —'r
DATE SYSTEM INSTALLED y"NAME SYSTEM INSTALLED UNDER 7 r 1 2le--14s�ZaId �--1
TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED 3
TYPE WATER SUPPLY Cd SPECIFY PROBLEM OCCURRING %rOct,-cC
DATE REQUESTED l INFORMATION TAKEN BY—a
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
IN
Parcel #: B300000063
Davie County, NC - Basic Estate Search
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Parcel #: B300000063
Account #:82515772
Owner Information
Tax Codes
116,25
17E JOSEPH MARK & WHITE JEANNA BAXTER
F242
ADVLTAX - COUNTY TA
Land:
NC HIGHWAY 801 NORTH
READVLTAX - FIRE TAX
133 060
MOCKSVILLE NC 27028
133,06
Property Information
Township
nd (Units/Type): 0.730 AC
CLARKSVILLE
[Address: 4242 N NC HWY 801
Deed Information
Local Zoning
Date: 11/2000 Book: 00352 Page: 0185
Plat Book: Page:
Legal Description
PIN
1.75 AC HWY 801 OFF
F 5823562096
Property Values
uildin :
116,25
BXR
2,49
Land:
14,32
Market:
133 060
ssessed•
133,06
eferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00352 0185 11 2000 WD Unqualified Improved 128,000
View Property Record for this Parcel View Man 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,
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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=1467836 9/20/2016