7180 Hwy 801Sq
r =- DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'*NOTE: Issued in'Compliance with G.S. of North Carolina Chapter 130 Article 13c i !.
Sewage /Treatment and Disposal Rules (10 NCAC,10A .1934-.1968 Permit Nuimbeir
`,:Name f ,y f% '% I', ,�'f Date' N25 O�
tis
Location �� / — rr l rr a,
Subdivision Name Lot No. Sec. or Block No.
Lot Size C�� ��. , House Mobile Home — Business Speculation
No. Bedrooms No. Baths- No. in Family c'V _
Garbage Disposal YES p NO B- Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES NO fl
Type Water Supplyf1 �, /F-lI
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
,1
:w Improvements permit by Azi
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by��_!A
Certificate of Completion- i���=. Date
"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in'NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department 3
Environmental Health Section R���D KpY
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone-�-
1. Permit Re ested B �• coh ke-1 Business Phone
2. Address
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: Houser Mobile Home Business
Industry Other
b) Number of people
6. aJ If house or mobile home, state size of home and number of rooms.
House Dimensions A/
Bed Rooms_ Bath Rooms— 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 3 urinals garbage disposal
lavatory 3 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 .24
b) Land area designated to building site - Q
c) Sewage Disposal Contractor am
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? A)D
What type?
This is to certify that the information is correct to the best of my knowledge.
S^ 30- Pq
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 da s for processingn
n� ��]]
%„ 'processing,,,
•/h B/'
Directions to property:
64_x -
10
DCHD (6-82)
Name
Address
FACTORS
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
lSOIL/SITE EVALUATION
e
AREA 1 AREA 2
Date
Lot Size �C
AREA 3 AREA A
1) Topography/ Landscape Position
9)
PS
c�
PS
PS
S
U
U
U
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
S
3) Soil Structure (12-36 in.)
Clayey Soils
S
S
S
S
1) Soil Depth (inches)
U
i) Soil Drainage: Internal
S
S
S
S
S/
External
f
S�
PS
U
PS
U
PS
U
'PS
U
i) Restrictive Horizons
-------------
Available Space�
-PS
f
PS
6
PS
qS1
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
UU
U
Site Classification
U—UNSUITABLE S—/SUITABLE P�--Provisionally Suitable
Recommendations/Comments:
Described by _
SITE DIAGRAM
DCHD (6-82)
Title C a Date
.XI
73
X2.
i
Parcel #: M500000022
Building:
162 74
Page 1 of 1
24
Land:
318,32(
Market:
481,30(
ssessed:
223,12(
ONVi71.1
;Davie County, NC - Basic Estate
Search
Unqualified
Cwtz'/.:
Davie County Web Site
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: M500000022
Account #: 82529084
Owner Information
Tax Codes
OBLE ROSA LEE M
ADVLTAX - COUNTY T
180 NC HIGHWAY 801 SOUTH
FIREADVLTAX - FIRE TAX
OCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 30.050 AC
JERUSALEM
ddress: 7180 S NC HWY 801
Deed Information
Local tonin
Date: 08/2007 Book: 2007E Page: 0206
Plat Book: Page:
Legal Description
PIN
3 AC HWY 801 LIFE ESTATE
5746410112
Property Values
Building:
162 74
BXF:
24
Land:
318,32(
Market:
481,30(
ssessed:
223,12(
Deferred:
258,18(
Sales Information
No. Book Page
Month Year Instrument
Qual/UnQual
Improved Price
1 00052 0565
01 1955 WD
Unqualified
Improved 0
2 00205 0351
08 1998 WD
Unqualified
Improved 0
3 2007E 0206
08 2007 WL
Unqualified
Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
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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/itsnetfView.aspx?prid=1478147 8/24/2016