637 Hwy 801N.. TS c � .:r iN� s+r �,14." 'b w.. tr c - .. d "! ''^ t
AUTHORIZATION NO: 0790 DAVIE COUNTY HEALTH DEPARTMENT
- Environmental Health Section PROPERTY INFORMATION
Peintittee's P.O. Box 848
Name: Mocksville, NC 27028 'Subdivision Name:
6s7 Phone #: 704-634-8760
Directions to property: Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION,
Road Name: Zip: aS 7 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/AuthorizationNumber 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
t j,Y 1 `Y Y1•dt y,yt 3 yn^I,a �} y .y4 .sY`.1 1� i 'jY ' ,-' .; i, -, .��',� ,•.%:
p4,x •`.,'r.� «�, '• 'k�-- i'�c �T, s . d P•.. :� w. ?y� , �, .;1"'h ^,r�pc x.,r�td d t...Y . 1�i0 yl
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Pe�liu '
r .'`Name: _ L '4j .��-.�'d�� � t"�.r7 r Subdivision Name:
directions to property: s l `/`it� Section: Lot:
"�. IMPROVEMENT
�4. PERMIT Tax Office PIN:# - -
tF Road Nam � >1 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
consfruction/mstallation 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 _ # BATHS 3 # OCCUPANTS '� GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: YesorNo
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)361J NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH' LINEAR Fr. D D
OTHER
• a
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
1
"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:
AUTHORIZATION NO. 74 OPERATION PERMIT BY: DATE:
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) _
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS, PROPERTY INFORMATION
4
Pet$e�s'
`Name:Subdivision Name:
jDirecdons to property: � .��r;, f,,r. �`�. • Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name. 4 '� J"= 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/installation 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 S # BEDROOMS # BATHS !r # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE, % # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY r i DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
t
SYSV,M SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �i r' ROCK DEPTH LINEAR FT. U'
1 �
' OTHER �..
•
REQUIRED SITE MODIFICATIONS/CONDITIONS:
i
e _
**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 # ;
SYSTEM INSTALLED BY: r
AUTHORIZATION NO. CJ ?"l OPERATION PERMIT BY: _� DATE: / -e2
1
**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 NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
NAME
ADDRESS
DIRECTIONS
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
Ale
% APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
f
/Y eaG Som a- PHONE NUMBER
/& SUBDIVISION NAME
Id
LOT # _
SITE 5 � a� C2o Qy� / �' e 3�- !�I o ll�e /,S a'n- d d
DATE SYSTEM INSTALLED 1 / 1,5� NAME SYSTEM INSTALLED UNDER �7
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING77
r,I?j -t4k -LdZ�, <-,LJ/
DATE
NFORMATION 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. 1/93
r7L
Parcel #: C70000010001
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Parcel #: C70000010001
Account #:53880000
Owner Information
uildin :
Tax Codes
BXF:
EWSOME JOEL M& NEWSOME BRENDA D
nd:
ADVLTAX - COUNTY T
Market:
37 NC HIGHWAY 801 NORTH
ssessed:
FIREADVLTAX - FIRE TAX
eferred•
DVANCE NC 27006
00187 0496 05 1996 WD
Unqualified
PropertY Information
Township
d (Units/Type): 1.000 LT::j
Vd'�ress:
FARMINGTON
637 N NC HWY 801
Deed Information
Local Zoning
ate: 05/1996 Book: 00187 Page: 0496
Plat Book: Page:
Legal Description
PIN
1 LOT HWY 801
5862861732
Property Values
uildin :
324 82 0011
BXF:
7,42
nd:
3300
Market:
36524
ssessed:
36524
eferred•
3
Sales Information
No.
Book Page Month Year Instrument
Quai/UnQual
Improved Price
1
00100 0059 10 1976 WD
Unqualified
Vacant 0
2
00169 0326 07 1993 WD
Unqualified
Vacant 60,000
3
00187 0496 05 1996 WD
Unqualified
Improved 0
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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=1475252 9/14/2016