5748 Hwy 801St V4
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AUTHQRIZAION NO: 0 9 0 B DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section z PROPERTY INFORMATION
Penmittee's P.O. Box 848
Name: Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760
Directions to property:'' mri'rJ Section: - Lot:
AUTHORIZATION FOR
j WASTEWATER
`y` " ` �'—T=` SYSTEM CONSTRUCTION Tax Offi e PI :# - -
7T
Road Name: , $Q Zip. 0i'1 a0
*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)
NO
*** TICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
Q
4iv�( -�� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEAL HSP ECIALIST . DA IS UED
Vtyl it*�'..F,g.S..htas A:w r 'tti .r�y eft=+fT x`+`"jLaw �� i yr �t+:s .ti =i Et;: �h`g i'�� '..:.� r�re„•y +�.�,y° 7u'anayyYi :a.'E`sgP �3wv .^,.�'� Y,rR
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—° DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PE ITS PROPERTY INFORMATION
Subdivision Name:.
�-Ijuecd6q to property: �'' , r' ' riG'�f. Section: Lot:
IMPROVEMENT
PERMIT Tax Offi a PIN :# _
4?+� p
a Road Name: . �a Ir~-�• Zip: c �Q
**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)
n ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
cA QM �T PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DA ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDINLG T YPR L # BEDROOMS 2— # 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 00r 'DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH —& LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**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:
,,
13W',1�
AUTHORIZATION NO.� OPERATION PERMIT BY: -Fati,P 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 WELL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
j
a / ,`= .4y �ijKa � �:�`•.. m ix?�.�,. .^,Ff., F ,r-, ..�i" re 6..y r a,l ..,� t° �'k":. >>S ,ay''i �n `iii"X"w «.'G'` ta.:,.:z., ,,:j;.p -. 2: `t .eFi.' Y1"
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PFfMITS PROPERTY INFORMATION
`Per�ttee's .
,Name _� '°'~ Subdivision Name:
Direction's to property4k Section: Lot:
f IMPROVEMENT ,
PERMIT Tax OfficePINI- -
r� ty +�
Road Name: i�t,!'t . `!� Zip: � f � ahQ
**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
constEuctionlinstallation 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)
1 4-11
(f ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
1. ) PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
r INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TY?'E # BEDROOMS _� # BATHS # OCCUPANTS s ---GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY CDS DESIGN WASTEWATER FLOW (GPD)
-�F `� NEW SITE .. REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE k6—GAL. PUMP WANK GAL. TRENCH WIDTH_ ROCK DEPTH 1_QY__ LINEAR Fr. �3
z
OTHER ,
_REQUIRED SITE MODIFICATIONS/CONDITIONS: _
IMPROVEMENT PERMIT LAYOUT
"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
y'
�+ k
1.
a
,t
"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
y'
�+ k
1.
a
C A. l).
Lot,J
"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:
1
AUTHORIZATION NO.y%g OPERATION PERMIT BY: <� -AQ I 11 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)
y'
�+ k
1.
a
SYSTEM INSTALLED BY:
1
AUTHORIZATION NO.y%g OPERATION PERMIT BY: <� -AQ I 11 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)
-?.,o v 4
NAM
ADDI
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) d
ONE NUMBER 0
- zed
BDIVISION NAME
LOT #
DIRECTIONS TO SITE
�� /l�rlg yl /4aj. ' Sia r14 In /ta.'V, !, 1! c
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY - NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY ��-�' SPECIFY PROBLEM OCCURRING
Ucej-00
DATE REQUESTED INFORMATION 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. 1193
Parcel #: L600000059
Davie County, NC Basic Estate Search
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Parcel #:L600000059 Account #:52756000
Owner Information
uildin :
Tax Codes
BXF:
YE RS GARLAND L & MYERS MARGARET B
Land:
ADVLTAX - COUNTY T
arket:
NC HIGHWAY 801 SOUTH
ssessed•
READVLTAX - FIRE TAXCKSVILLE
Deferred:
NC 27028
PropertV Information
Township
nd (Units/Type): 4.130 AC
JERUSALEM
ddress: 5740 S NC HWY 801
Deed Information
Local Zoning
Pate: 01/1900 Book: Page:
Plat Book: 12 Page: 40
Legal Description
PIN
17.86 AC HWY 801 4.13 AC
5756869977
Property Values
uildin :
52,84
000111
BXF:
9,20
Land:
24,90
arket:
86,94
ssessed•
86,94
Deferred:
Sales Information
No Sales Data found.
View Property Record for this Parcel View Mao 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,
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.claviecountync.gov/itsnetfView.aspx?prid=1481619 8/30/2016