3707 Hwy 801S0
6450
(140
141
Davie County, NC
WARNING: THIS IS NOT A SURVEY
rceflnformatiori
Parcel Number:
J80000001703
Township:
Fulton
NCPIN Number:
5778903463
Municipality:
Account Number:
82517569
Census Tract:
37059-804
Listed Owner 1:
LANIER SHIRLEY SMITH
Voting Precinct:
FULTON
Mailing Address 1:
3707 NC HIGHWAY 801 SOUTH
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-7114
Voluntary Ag. District:
No
Legal Description:
0.741 AC NC HWY 801 LIFE ESTATE
Fire Response District:
FORK
Assessed Acreage:
0.70
Elementary School Zone:
CORNATZER
Deed Date:
2/2010
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
008180394
Soil Types:
PcB2
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
WS -IV -P
Building Value:
71190.00
Outbuilding & Extra
8400.00
Freatures Value:
Land Value:
16540.00
Total Market Value:
96130.00
Total Assessed Value:
96130.00
141
Davie County, NC
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harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
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APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT �j`
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN
pISSUED.
�/ Home Phone-
1.
hone 1. Permit Requeste By 4i� cCh Business Phone
2. Address a E41 a 14 bL-0 r o _ 77, lam' o) %OD 6, _
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ✓ Alter Repair
b) Privy_ Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Homed Business
IndustryOther
b) Number of people a
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions Z71 X 6.0
Bed Rooms —3_ Bath Rooms —a Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes oZ urinals garbage disposal
lavatory a showers washing machine
dishwasher sinks
8. a) Type water supply: Public Private—/ ' Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 0/7 to CC C t- C
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? e S
What type? 4 6 t S -
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
J�
c2m(
t TV 4,
a
AUTHOR$ZATION NO: 0693 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's,., P.O. Box 848
Name: ;.;e1a92&.P-f2_ Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760
Directions to property: ,�,CZG',Z,,g,:✓ f�zf'lj
--� AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Section: Lot:
Tax Office
fjPIIN:# - -
41
Road Name Yd1S • Zip: 49 / n
OO(
**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)
�i l — �, % J ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
?NVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
SCO
DAME COUNTY HEALTH DEPARTMENT
` a - IMPROVEMENT AND OPERATION PERMITS
Permrttee's� • .
Directions to property:. ;
JYMPROVEMENT
PERMIT
PROPERTY INFORMATION',
Subdivision Name:
Section: Lot:
Tax Office PIN:#
RoaName: Zip: O��
**NOTE** This Improvement Permit'DOES NOT authorize the construction or installation of aseptic 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 # BEDROOMS # BATHS_„ # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
DESIGN WASTEWATER FLOW (GPD) �� NEW SITE REPAIR SITE
LOT SIZE TYPE WATER SUPPLY ���/ �'':-'`�
SYSTEM SPECIFICATIONS: TANK SIZE _GAL., PUMP TANK GAL. TRENCH WIDTH /<� ROCK DEPTH LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**CONTACT A REPRESENTATIVE OF THE DA
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1::
OPERATION PERMIT
COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
INSTALLED BY:
�t
U
AUTHORIZATION NO. ,!XeOPERATION PERMIT BY: �C 7� DATE: J
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I1 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)
gnu
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION;,
Permittep.,
Directions to property:
IMPROVEMENT
PERMIT
Subdivision Name:
Section: Lot:
Tax Office PIN:# -
31 10f
t1 I ., q/
Road Name: Y u! ---� . Zip: (t/C/(r
**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
,* r' 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, Sy # BATHS --�2 # OCCUPANTS -;f 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) --s'% NEW SITE REPAIR SITE
i
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH .- Cir ROCK DEPTH 'LINEAR FT.:" rl
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"CONTACT A REPRESENTATIVE OF THE DAV COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM II
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:36.P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760.
OPERATION PERMIT
D SYSTEM INSTALLED BY:%+C?-
AUTHORIZATION NO. ! OPERATION PERMIT BY:DATE: "L�
"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)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER�'y�
ADDRESS` 2b -7/D�Gy� YD/ •� SUBDIVISION NAME
1�H{✓�f LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS "-yNUMBER PEOPLE SERVED
�C'
TYPE WATER SUPPLY /( SPECIFY PROBLEM OCCURRING
DATE REQUESTED=S INFORMATION TAKEN BY AW/
This is to certify that the information provided is correct to the best of my knowledge, and that 1 understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193