2692 Farmington RdHEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Melissa D Dehart
Address: 2692 Farmington Road
City: Mocksville
State2ip: NC 27028
Phone #: (336) 940-2988
For Office Use Only
*CDP File Number 192147-1
County ID Number:
Evaluated For. HDR/WWC
PERMIT VALID 0 4/ 0 7/ x 0 a 0
UNTIL:
Property Owner: Melissa D Dehart
Address: 2692 Farmington Road
City: Mocksville
State0p: NC 27028
Phone M (336) 940-2988
Property Location & Site Information
Address2692 Farmington Road Subdivision: Phase: Lot:
Road # Mocksville NC 27028
SINGLE FAMILY Township:
'Structure: Directions
# of Bedrooms: 3 # of People: Hwy 158 east left on Farmington Rd, cross Hwy 801 Property on left
'Water Supply: N/A
Basement: n Yes ❑ No
Type of Business:.
Total sq. Footage: No. Of Employees:
11 1
'Proposed Improvement:
Replacing Home
Maintain 5 foot setback to any protion of the septic system
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? OYes ONO,
Applicant/Legal Reps. Signature'. *Date:
*Issued By: 2140 -Nations, Robert *Date of Issue: 0 4/ 0 8/ 2 0 1 5
Authorized State Agent:
**Site Plan/Drawing attached.**
Hand Drawing OlmportDrawing
w
Aied W
Davie County Health Department
p�i$ f�Environmental Health Section h
P.O. Box 848 ,
210 Hospital Street '
p ' Courier #: 09-40-06 1 � � 1
U 13 vacet Mocksville, NC 27028
Phone: (336) - 753 - 6780 Fax: (336) - 753-1680
ON TE WA ATER CERTIFICATION
(Check On Replacement Remodeling Reconnection
1 Q q
( Name: AS /, � Phone Number 3 -! l (Home)
Mailing Address: 23L 9�d - 7, ej 10 (Work)
27O -L d Email Address: UNAXi'Nood J VOOQa 0 d . Cu1��-,
Detailed Directions To Site: �J� o D 5 /
V 1
g'lmill 6,k) e4ie- Yadk
Property Address: (p pllj/�, //V(�U/(/AW r d�� SQi�i`ttrl N 9
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: C� �I ��Uq�/ Type Of Facility:j��
Date System Installed (Month/Date/Year):% 9 -1 Number Of Bedrooms: -3 Number Of People:
Is The Facility Currently Vacant? Y^es , 16' If Yes, For How Long?
Any Known Problems? Yes /1V % If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: Mct�cc�� rL r,x 6-02. Number Of Bedrooms:
Pool Size: 1 Garage Size: Other:
Requested By: 0 , 0 14-- .ate Requested:_
(Si re)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist
Number of People.
-- 3 - 2,L' /S
Date:
*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.
Cash,theck Money Order #
Amount:$
Paid By: Received By:_
Account #: 1191-47 Invoice #:
Date:
Appraisal Card
DAVIE COUNTY, NC
LUHM FAMILY TRUST SLUNK HERBERT B NANCY TRUSTEES Ret,m/Appeal Nole,: Parcel: BS -000 -Go -109
692 FARMINGTON RD PIAT: / UNIQ ID 885
2520907 ID N0: 58530823]1
COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1
awl Year: 2013 TeX Year: 201510.25 AC OFF SPILIMAN RD 10.130 AC SRC- Inspection
gal:e6 by 04 on 01/01/2005 03006 SPII.LMAN RD Tw-03 Cl- FR -OB EX- AT- IASTACTION 20140319
CONSTRUCTION DETAIL
", -. MARKET VALUE -'- DEPRECIATION CORRELATION OF VALUE
OTAL POINT VALUE
:. ,.
BUILDING
" ADMSTMENTS
VSE MOD AfGa. VAL RATE RCN EYB AYB REDEHCE TO
91 GOOD I DEPR. BUILDING VALUE - CARD
OTAL —0—ENT
TYPE: Vacant DEPA. OB/XF VALUE - CARD
A=R
TOTAL QUALITY INDEX
MARKET LAND VALUE - CARD
STYLE: OTALMARKET VALUE -CARD 1207
OTAL APPRAISED VALUE - CARD 72,0)
TOTAL APPRAISED VALUE -PARCEL 72,0)
OTA RESER 5 ARCEL
-
TOTAL VALUE DEFERRED - PARCEL
TOTAL TAXABLE VALUE - PARCEL 72,07
ILDING VALUE
BXF VALUE
D VALUE 67,83
RESENT USE VALUE
EFERRED VALUE
TA A )
CODE DATE NOTE NUMBER --AMOUNT
OUT:
WTRSMD:
SALES DATA
F
ECORD ATE .DEED iNDIUTE SALES
k
OOK AGE R RI E
WD
HEATED AREA
NOTES
ROM L Y REECE
UBAA
:. :UNIT QAID% SIDE : ANN DEP % : .QB/%F DEPR
GS
1. TYPE AOT
RPL OD UA ESCRIPTIO COUN TH NIT :PRICE COND:' LOGe FACT YB B RATE: OV GOND VALUE
OB XF VALUE
-IREPLACE
UBAREA .:::
OTALS
WILDING DIMENSIONS
AND INFORMATION
THE'
D3USTMENTS
IGHIST
ND NOTES
LAND
TOTAL
NO BEST
USE
LOCAL
FRON
DEPTN/
LND
COND
RF AC LC TO:
CAD
:UNIT
LAND UNT TOTAL
ADJUSTED
LAND. OVERRIDE LAND
SE
CODE
ZONING
TAGE
E
SIZE
NO
FACT
OT - :
TYPE
PRICE
UNITS TVP AD3ST
UNITPRICE
VALUE VALUE NOTES
URAL
0120
0
0
1.1460
4
0. 300
1 -1 +00 +00
PD
8,500.00
10.13 AC 0.83
,114.5
207
00
OTAL MARKET
LAND
DATA
10.13
72,070
OTALPRESENT USE DATA
al�ti14, r,IP 01/y
__
Owner: BLUHM FAMILY TRUST
Page 1 of 1
http://66.226.39.229//ITSNet/AppraisalCard.aspx?parcel=B500000109 3/18/2015