942 Hwy 801NPennvttre's DAVIE COUNTY HEALTH DEPARTMENT
Name:
.%,f t;, jr� Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property: ! ��° %�.�c) ,�l. Mocksville, NC 27028 Subdivision Name: I
Phone #: 336-751-8760 i
- �%1 '.k' . ".--'>.'�� .�tJ•f' Section: Lot:
=4 AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION gLlZ AI j�w� I/ � �r--
AUTHORIZATION NO: 002673 A Road Name: /7 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
J ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
. Gr.�,1> i✓ 9`�� fidIS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 1
RESIDENTIAL SPECIFICATION: BUILDING TYPE L # BEllROOMS y5-7# BATHS _ # OCCUPANTS -4 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIF,T%# SEATS INDUSTRIAL WASTE: Yes or NNo.�^�
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIRSITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL: TRENCh WIDTH=-� �' ROCK F/6TH LINEAR Fr. �0
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
6
P`C lI
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30
OPERATION PERMIT
A/
oil
0
THE IIAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
BY:
�OAUTHORIZATION NO. S'�y 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 SATIISS/F�A/CTORILY FOR ANY GIVEN PERIOD OF TIME.
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f' Pernnttee's r DAVIE„COUNTY HEALTH DEPARTMENT
Name: ` t Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
41, i.Dire tiens to property: �'{ ' ` �' % Mocksville, NC 27028 Subdivision Name:
ie#33,6-751-8760
- Phon
Section: Lot.1
AUTHORIZATION FOR
,. WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
qL/2 /NC 11WV
R
AUTHORIZATION NO: 002673 tai Road Name: Ztpa70zn
**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)
p
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTWSPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE R # BEDROOMS _�# BATHS --r::# OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) . NEW SITE REPAIR SITE ��
SYSTEM SPECIFICATIONS: TANK SIZE `PYGAL. PUMP TANK GAL'' TRENCH WIDTH DEPTH T LINEAR
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
y
t,
.,t
FOR FINAL
OPERATION PERMIT
ws
I
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s
r
�t
FOR FINAL
OPERATION PERMIT
ws
I
ON OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30\- M. O THE Y Oy, INSTALLATION. TELEPHONE # IS (336) 75178760.
A
SYS E INS LE BI�76H.�c
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c
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:Q
"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
';DCHD02M wised '
s
r
ON OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30\- M. O THE Y Oy, INSTALLATION. TELEPHONE # IS (336) 75178760.
A
SYS E INS LE BI�76H.�c
�b
c
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:Q
"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
';DCHD02M wised '
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLIC
ATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME f Lu PHONE NUMBER
ADDRESS �Y % N� { � �o� N, MOCkYl f KUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
r
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVEDn -
TYPE WATER SUPPLY
SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, nd t I understand I am responsible for all
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. ,/93
-1 "7S
incurred from this application.
Parcel #: C700000053
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: C700000053
Account #:58469420
Owner Information
uildin :
Tax Codes
BXF:
RATER C WAYNE& PRATER LUCY H
nd:
ADVLTAX - COUNTY T
Market:
42 HWY 801 N
eased:
FIREADVLTAX - FIRE TAX
eferred•
DVANCE NC 27006
75,000
3 00584 0114 12
Property Information
Unqualified
i- Township
nd (Units/Type): 19.600 AC
4 00114 0014 10
FARMINGTON
[Address: 942 N NC HWY 801
Improved
75,000
Deed Information
Local tonin
ate: 12/2004 Book: 00584 Page: 0114
Plat Book: Page:
Legal Description
PIN
0.019AC HWY 801
5862482688
Property Values
uildin :
490,94 0011
BXF:
83,10
nd:
21578
Market:
78982
eased:
78982
eferred•
Vacant
Sales Information
No. Book Page Month Year Instrument
Qual/UnQual
Improved
Price
1 00110 0627 05
1995 WD
Unqualified
Improved
0
2 00117 0747 05
1987 WD
Unqualified
Vacant
75,000
3 00584 0114 12
2004 WD
Unqualified
Improved
266,665
4 00114 0014 10
1986
Qualified
Improved
75,000
View Properly Record for this Parcel View Map for this Parcel View Tax Bill Information
Page 1 of 1
oA.j�
000rivi-Is
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=745712 9/22/2016