307 Cedar Grove Church RdDavie Co�ntv, NC Tax Parcel Report Tuesday, October 11, 2016
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:
WAK1V11V(T: '1'Hl� 1� 1VU1' A �UKVLY
Parcel Information
J70000010307
5777155904
14551000
CEDAR GROVE MISSIONARY BAPTIST
307 CEDAR GROVE CHURCH ROAD
MOCKSVILLE
Land Value:
Total Assessed Value:
NC
27028-0000
1.5 AC E OFF CEDAR GROVE
1.54
10/ 1988
001450545
0.00
14830.00
14830.00
9"��°'F Davie County,
�o�,x�� NC
Township: Fulton
Municipality:
Census Tract: 37059-804
Voting Precinct: FULTON
Planning Jurisdiction: Davie County
Zoning Class: DAVIE COUNTY R-A
Zoning Overlay:
Voluntary Ag. District: No
Fire Response District: FORK
Elementary School Zone: CORNATZER
Middle School Zone: WILLIAM ELLIS
Soil Types: PaD,Pc62,PcC2
Flood Zone:
Watershed Overlay: DAVIE COUNTY
Outbuilding & Extra 0.00
Freatures Value:
Total Market Value: 14830.00
AII data is provided as is without warranty or guarontee o►any kind elther expressed or implied Including but not Ilmited to the
Implied warrantios of inerchantability or fitness for a paRicular use. AII users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or eauses of actlon due ta
or aristng out of the use or inability to use the GIS data provlded by this website,
.��. ; : _ . ;^ _ �. . . . _ � ���
A�JTHCiRIZATION NO: ���� DAVIE COUNTY HEALTH DEPARTMENT
- ��' ' Environmental Health Section PROPERTY INFORMATION
Permittee'�� ,{� � �. _�'� P.O. Box 848
Name: ��'" .,��; �' d��i'"?�a ,'�'�;`��"` -�'���� Mocksville, NC 27028 Subdivision Name:
' � _^�� ��� ,, ,. � Phone #: 704-634-8760 `
Directions to property: �' �'��' c--- �..^ ��f /� c Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# ��� - �� � "
. SYSTEM CONSTRUCTION
, . � . . . . . . . . .. � . . n / � 3 .
Road Name: LGCtAY' (rr� �� �' l zip' �'�" ��" C�v� �
**NO'TE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Counry Environmental Health Section prior
to issuance of any Building Permits. T'his Forn�/Authorizadon 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)
ENVIRONMENTAL HEALTH SPECIALI;
r ,/—� ��#
— _�
iT DATE ISSUED
***N01TCE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALm FOR A PERIOD OF FIVE YEARS.
" :e+ '�» � ``R �
u";`y �° ���+` DAVIE COUNTY HEALTH DEPARTMENT
._ �:
.- �'��" r JMPROVEMENT AND OPERATION PERMITS
.�
. -�- f :
�'Permit[ee's.: �' ,.-r °�� :'g ,...,�.f.,�"���.
fr �,r.('� .
PROPERTY INFORMATION
� Name: � ' '='"r" ' k'� ' "f�""��'' ` A �° ''� Subdivision Name:
� ' t__., '; ;„�:
�- � - :
Direclions to property: `� ��� ' . Section: Lot:
.• IMPROVEMENT �r � .�„ , �
PE�T Tax Office PIN:# r'��� �� � _ �' `! � % "� "
,,
� ' Y
Road Name � �_'� �: a , " � „� r.�: � ``• � ` �,.Llp` ``�. F�; �; .=i .w�
**NOT'E** This Impmvement Pemut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUT'HORIZATION FOR WASTEWATER SYSTEM CONSTRUCT'ION must be obtained frc�m this Department prior to the
conshuction/installation of a system or the issuance of a building pernrit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
' yr ,,+ ,, * _�'' ***NOTICE*** THLS PERNIIT IS SUBJECT TO REVOCATION 1F SITE
a` , y ..; �. �' aa , '' . .��; '���? � � •`�- ,`" " '. � ;� PLANS OR TI-IE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMTI' BEFORE
INSTALLING Ti� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS � # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYP�" -�`n�# PEOPLE 7,5�# PEOPLE/SHIFI' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY fii/t %/ DESIGN WASTEWATER FLOW (GPD) .�r�,� NEW SITE REPAIR SITE ��
�,r�,,,�, . �,���'
SYSTEM SPECIFICATIONS: TANK SIZE«-�=CL-GAL. PUMP TANK GAL. TRENCH WIDTH �- �� ROCK DEPTH �� LINEAR Ff. ��
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
_... ...�,.....Y,
**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) 634-8760.
OPERATION PERMIT
SYSTEMINSTALLEDBY: a=_^��1% �l�tCi��
g
r.. L� ���1
AUTHORIZATION NO. � � OPERATION PERMIT BY: 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 OSl46 (Revised)
�
��
��
� APPLICATION F�?R SITE ]EVALUATION/IIVIPROVEME?�T PE�MIT � ATC
Davie County IYealth Department
Enviran�nental Health Section �
P.o. Box s4s j��o `�
Mocksville, NC 27028
{704) 634-$760
��**I�IPORTANT�'�** THdS APPL�CATION CANN4T BE PROCESSED U1�iL��SS ALL
THE REQUYRE� INFQRMA,TIUN �S PR4ViDED.
1. Name ta beBilled �' A�t jL, 4--�.�t �1���=--� ContactPerson �-� �1�����' ��' ��
Mailing Address �{ `�Q • �t?,�;�/��� Home Phone �� � � Y ,�! r
Cicy�s�ace/zip u r ��1 �,�"��/. C` - Z.�'�1 ��l Business Phone ��.cf' ��'� Z''�
.�
2, Namc on 1'ermidATC if Different than Above , i�0 �:�.�K �•��i��• ��/�?` �i� /lr'lrr� .
MaitingAddressf.,F��, /�;�� ��l,�l F= ("��i�n, �C! �� City/StatelZap ��{',�''Sr���L� 1_�.��'. Z,ZD 1�
3. Application For: [ j Site Evaluation �' Improvement Permit & ATC (] Both
4. System w Serve, (] Hvuse [] lvlobile Homa (] Business [] Industry �;] Other
5. If Residence: # Peoplz # Bedrooms # Bathrooms [] Dishwasher [] Garbage Disposal
[ J Washing Machine [ j BasemtntlPlumbing (] Basement/No Plumbing
6. If Business/C?ther: Specify type # People�_ #Sinks� # Commodes �
# Shawets„�,_, # Urin�ls � # Water Coolers --`'�
If Foodservice: # Seats Estimated Water Usage (gallons per day j
7. 'fype of watex supply: [ j Cour.tylCity � Weil j j Community
8. Do you anticipate additions or expansions af the facility this system is intended to serve? (� Yes [�j� No
lf yes, what type?
T:lt�i: ,t t�1.,�1'! c.�r�� ��1I�1; 1'l.,1N
PROPERTY INFORMATI�N REQUIRED: '�** IMPiIATANT **�.Y��&�Y' OF TiiE �'ROPERTY MUST BE
SLBMITTED WITH THIS APi'LICA'I'YON.
Praperty Dimensions: � �- �.�-�—.��r` a� �W1�ITE DIRECTIONS (trom Mocttsville) TO PROPER'I'Y:
Tax Oflice PIN: #�� ' 7,��� a�= _ �' ! � � � � c.��r r".�� i` d 1Y' �P/; 'r �(� ��
Property Address: Ro me �%C7J ..��'� ,�' ��(A.r� ,�',�'�;,� ''"UF' CS,�!' �?
�
City/'Lip /�/�r� �'c'�,� !L.G.(.` ,, /7,� � C.� - � � �a1rL ��'r % � t� r�l �''1a ��1� /u/ l.�
w-_____,..
If in Subdivision provide information, as follows: i C���i,�TZ% f� C� N �,�� �
�
�
Natne: '
�
�
�
Sectian; T.ot #: �
This is to certify that the informatian provided is cozrect to the best of my knowledge. I understand that any pe:mit(s) issued hereafiet are
subjeet to suspension or revocatian, if the sice plans or incend: d use change, or if the information submitted in lhis apptication is falsifit,cl a�
changed. I, aiso, understand that I am responsiblc for a!l charges incurred from this application. 1, heraby, give consent to the Authorize�
Representadve of the Davie Caunty Health Department to enter upan above described property located in Davie County and own�
to canduct�� testin� procedures as necessary to determine the site suitability.
DA'rE�Z ZS--S' 7
Ravised DCHD (06-96)
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