1286 Deadmon Rd i A
Ekavie County,NC Tax Parcel Report�� I 666 7 Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information -
Parcel Number: K60000002701 Township: Jerusalem
NCPIN Number: 5757409334 Municipality:
Account Number: 8301235 Census Tract: 37059-807
Listed Owner 1: BLACKWELDER DEANNA SHAMEL Voting Precinct: JERUSALEM
Mailing Address 1: 1286 DEADMON ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 1.134 AC DEADMON RD Fire Response District: JERUSALEM
Assessed Acreage: 1.01 Elementary School Zone: CORNATZER
Deed Date: 7/2012 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 008970236 Soil Types: GnB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 201610.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 17700.00 Total Market Value: 219310.00
Total Assessed Value: 219310.00
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County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
no tf p�; NC or arising out of the use or Inability to use the GIS data provided by this website.
Davie County Health Department
` 9_►836 nmental Health Section
..: o � P.O. Box 848. �-
-� • ' 0 3 210 Hospital Streets `
0 'Courier# : 09-40-06
` Mocksville, NC 27028
Phone:(336)-753-6780 Fax: (336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement . Remodeling Reconnection
Name: C Phone Number d•— (Home)
Mailing Address: �G.�ij �!/J . (Work)
i
C r. d Z IS Email Address:
Detailed Directions To Site: Q 6 /10/) _E f' �Jh.S11QJ
Property Address: LG ,
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility: 4LW C
' '
Date System Installed.(Month/Date/Year): Number Of Bedrooms: Number Of People:_
Is The Facility Currently Vacant? Yes No If Yes,For How Long?
Any Y_ own Problems? Yes No If Yes,Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility:_� _�- f 1,1,P7/,o ayyj Number Of Bedrooms: Number of People_
Pool Size: 1w Garage Size: 3D Y 41 Other: SC/aldp�I Zd Y 2 0
Requested By: OL� Date Requested: 5 '
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
-------------
Comments:
Environmental Health Specialist Date: S/��?0//
*The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order # Amount:$ Mxo Date:
Paid By: Received By:
Account M q�q9a0057 Invoice#: l,�d3