2207 Hwy 801Swermittee's,' r , DAVIE COUNTY HEALTH DEPARTMENT
Name t-�, a ('ter - ,�r.� Environmental Health Section PROPERTY INFORMATION
w P.O. Box 848 .
Directions to propeRy�'`.r` %'. Mocksville, NC 27028 Subdivision Name:
° Phone #: 336-751-8760
_•fr ;'� r,: /'"tx .; rr . a ;•_ Section: Lot:
AUTHORIZATION FOR
''�,y'..! r t. , . _ .}, w.: f,. WASTEWATER -
Tax Office P -I -N7:#
, SYSTEM CONSTRUCTION /
AUTHORIZATION NO:, A. ; Road Name:— ` S 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 Forrn/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)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�--- .c
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRON EMEM NTALfiEALTH SPECfkdST DATE ISSUED
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 DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS:..TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fyv
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
V DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAM
DIRECTIONS TO SITE - / 7`7 —
PHONE NUMBER ` `O
BDIVISION NAME
LOT #
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY /NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY / it SPECIFY PROBLEM OCCURRING z
DATE REQUESTED_ c �0/ INFORMATION TAKEN BY,----,yT��
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 #: G8130B0005
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Parcel It:G8130B0005
Account #:17076370
Owner Information
uildin :
Tax Codes
BXF:
OOPER GARY L& COOPER TERESA L
nd•
ADVLTAX - COUNTY T
Market:
207 NC HIGHWAY 801 SOUTH
ssessed•
FIREADVLTAX - FIRE TAX
eferred •
DVANCE NC 27006
Property Information
Township
nd (Units/Type): 1.960
SHADY GROVE
ddress: 2207 S NC HWY 801
Deed Information
Local Zoning
ate: 05/1992 Book: 00163 Page: 0839
Plat Book: Page:
Le al Description
PIN
1.96 AC HWY 801
5789372908
Property Values
uildin :
112,31
BXF:
nd•
34,83
Market:
147 14
ssessed•
147,14
eferred •
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00163 0839 05 1992 WD Qualified Improved 85,000
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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=1460110 8/31/2016