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118 Austine Lane Lot 36Davie County, NC I Tax Parcel Report Tuesday, January 3, 2017 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: H7030A0018 Township: 5769963170 Municipality: 55686000 Census Tract: PATTON ALFRED RAY Voting Precinct: 761 BAILEYS CHAPEL ROAD Planning Jurisdiction: ADVANCE Zoning Class: NC Zoning Overlay: 27006-7144 Voluntary Ag. District: LOT 36 GREEN BRIER ACRES Fire Response District: 0.46 Elementary School Zone Land Value: Total Assessed Value: 6/2016 Middle School Zone: 010211151 Soil Types: 0004 Flood Zone: 173 Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: Shady Grove 37059-804 WEST SHADY GROVE Davie County DAVIE COUNTY R -A ADVANCE SHADY GROVE WILLIAM ELLIS GnB2 DAVIE COUNTY No All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the i I Davie County, ` Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the (9j County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to I NC or arising out of the use or Inability to use the GIS data provided by this website. t ATION NO: i hAVIE COUNTY HEALTH DEPARTMENT eNarrie!*�, Environmental Health Section PROPERTY INFORMATION ittee's � /j � P.O: Box 84$i-ff� �✓<%� Mocksville, NC 27028 Subdivision Name: , ,►-� t>�lJi �r } // Phone.# 336-751-8760 Directions to property: /�.�� /�� "' r.�r'4/-."/AUTHORIZATION FOR Section: / Lot: �Ca 1;�� f ±, Jit r, WASTEWATER Tax Office PIN:# - - C: SYSTEM CONSTRUCTION /� } lr7l. Road Name: 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) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION "';'12 IS VALID FOR PERIOD OF FIVE YEARS. ENVIRO MENTAL HEALTH SPECIALIST DATE ISSUED 'IJDAVIE COUNTY HEALTH DEPARTMENT ^PP;,rmitt IMPROVEMENT AND OPERATION PERMITSPROPERTY INFORMATION - Directi6ps to property: Subdivision Name "�N' .' .~�' fir''., '• Section: Lot: .--1 IMPROVEMENT PERMIT Tax Office PIN:# - - Road Name: Zip: _ **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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NUTIUE*** 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 , jd # BEDROOMS — # BATHS --V-# 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) ��G/�/ NEW SITE REPAIR SITE 21/ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH' -Ir ROCK DEPTH LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT *APPROVED FFFLUEM FILTER* *RISER(S) IF 611 PEL014 FINIMiEA G a f (` "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECT STEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # I�� —F760 I OPERATION PERMIT SYSTEM INSTALLED BY: IV D 0 � AUTHORIZATION NO. '04 OPERATION PERMIT BY. DATE: "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. DCHD 05/96 (Revised) J. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &c A �� Davie County Health Department Environmental Health Section(% P.O. Box 848/210 Hospital Street ��iV J Mocksville, NC 27028 6' (336) 751-8760 <900,2 Q4N�' ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THEmrunn r INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inst 1.Name to be Billed , F_1 Contact Person / / (y i�. Mailing Address I 01 V 2 Home Phone - {1 � — b,53 : \ City/State/ZIP 1(1 ' L- r) Business Phone 1 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For:.ate Evaluation Improvement Permit/ATC ❑ Both X 4. system to Service: ❑ House U"Mobile Home ❑ Business ❑ Industry ❑ Other i 5. If Residence: # People ! # Bedrooms # Bathrooms Y Dishwasher Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. r i ! Property Dimensions: ! 0 �n�/v, v j� WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 1 �sl l -/'62q Property Address: Road Name t—tl�t S �� 2 1Ce ©C' i�o�'FZ 4\V aN City/Zip If in a Subdivision provide information, as follows: Name: -) IC' f �e flN Au5�1 Ne �a e �' -Fa last f cam; lel Oir P�i Section: Block: Lot: Date Property Flagged: (h:c, 60rX i 'H K _0 L This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suita ility. DATE SIGNATU ��f THIS AREA MAY BE USED FOR DRAWING YOUR SITE (In lude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). QCco r Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. p Invoice No. + i i �l i; _ I t -" __,a.. ..�Jw. �:�--•—_'.'�- t,-, J '.' �1 .LC 0 av � � -- :�•� � I. ` w 36 77 43` IC`s ._: l�_ __..�__ ,�)✓t ��` r� -. <� Ll' .. !C%tJJf�i L�iU j I!V ✓'7' i jjj t Li Y" l r (til /�r ► e : v L v' I - I �� +' 1 - . i r �r rr'.l cS c.: -v 4: ._.. _' ' S�'w �' �^• �,�4 M��' _ ! �*� .rt Ir; Eft .�_ c �� .:.+ �Y' r -`-- \. .., :�- ...-._. `. .,. ZL sl ra• � Gr„ � .. .. ..._._ .._....._. � - ._.____ -_. _---.. J,. ._ _._ mos_ ..�V`{j 1 3 _ �`, ��,� ! Ccs.. r' • ^,- , � F� i /�•��'r•,�,.�.�,�r _ ', 3-7 �•� �i Vic: � j} + ,d,� c. ---' .. __..f_._-.- ��— ,��,�,"'1°,.` . '� ,c; ,..��"`��"-.,s+-.--.• -s_ _ �Q OlYt pi? �..."_ _ - dei �F��' F',�' � .� c Y • �, �,`��-� . !�':�y..--•--.•ti.m.-�.�� !, � v ; . '�...�J � iui. � !c� i' �t �" ---�wf-�.._. _ _..... 4' ��"•� Es'w ' � ��E ; 4t - j � •� � t ✓✓ i../ 1 j I rMIN, GY • ll" � t Al • F ,. sem: �" s . c:' I� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME L PHONE NUMBER I DIRECTIONS TO S DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER N NAME LOT # TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING v I 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. It/93 i