183 Fork Bixby RdDavie County, NC I Tax Parcel Report lW A Wednesday, September 28, 2016
141
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie County, NC implied warranties of merchantability or fitness for a particular use. All 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
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
WARNING: THIS IS NOTA SURVEY
Parcel Number:
J7050A0002
Township:
Fulton
NCPIN Number:
5777199245
Municipality:
Account Number:
24424870
Census Tract:
37059-804
Listed Owner 1:
EPISCOPAL CHURCH OF ASSENTION
Voting Precinct:
FULTON
Mailing Address 1:
183 FORK BIXBY ROAD
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R-A,R-20
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
P/0 LOT 1 A M FOSTER EST
Fire Response District:
FORK
Assessed Acreage:
3.61
Elementary School Zone:
CORNATZER
Deed Date:
10/2002
Middle School Zone:
WILLIAM ELLIS
Deed Book f Page:
004420480
Soil Types:
PcB2,PcC2
Plat Book:
0002
Flood Zone:
X
Plat Page:
021
Watershed Overlay:
-
Building Value:
461660.00
Outbuilding & Extra
1440.00
Freatures Value:
Land Value:
42900.00
Total Market Value:
506000.00
Total Assessed Value:
506000.00
141
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie County, NC implied warranties of merchantability or fitness for a particular use. All 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
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
AUtI HORIZATION N0: DAVIE COUNTY HEALTH DEPARTMENT Z
Environmental Health Section PROPERTY INFORMATION
`-Perrmtt e's' ��% ff P.O. Box 848
Name: f�+J /'r r>a i�%� < �I�t. i�5!'�i_ nor! Mocksville, NC 27028 Subdivision Name:
� Phone # 336-751-8760
Directions to property: %�"3 f�r�` e1`�;� s u �cj Section: Lo[:
/ AUTHORIZATION FOR
, %/w't�;-r'N /�J^•� • 27,DD( WASTEWATER Tax Office PIN:# =r77 - 19 11P 3
SYSTEM CONSTRUCTION
Road Name: -r9 r ;YL Zip: 2 7G7 2 4
**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
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
"CONTACT A REPRESENTATIVE OF THE DAVIEC U Y HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
► BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P. THE DAY OF INSTALLATION. TELEPHONE # I§(/M NOM.
I T'7r%_7=4
%-7=4 ^.7/ A
OPERATION PERMIT
AUTHORIZATION NO. ERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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)
DAVIE COUNTY HEALTH DEPA!RTIV' NT
IMPROVEMENT AND OPERATION PEITS i PROPERTY INFORMATION
•L'TY- .. i Y � j
}% 1 ' a. 'r. as '1i •+...1 G`
Subdivision Name:
Directions to property: Section: Lot:
} IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name: F t E Y;` / :' Zip, ,, a
**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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** 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 # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
SP,41s
COMMERCIAL SPECIFICATION: FACILITY TYPE('/,O,,-,//,/4# PEOPLE,2M # PEOPLE/SHIFT # SEATS a 3D INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTHL?/< ' ROCK DEPTH � LINEAR Fr.. ; I)b
OTHER
—z
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LA
/ 1IV C
f
147"ItRI-SEM) IF 611 ai._LQ:i FIIII8HED GP,ADcf,
•;- /Ii i"' !Oe
"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 # IVI')b4OA1106b.
(325)751-8760
OPERATION PERMIT
I AUTHORIZATION NO.
OPERATION PERMIT BY:
SYSTEM INSTALLED 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 05/96 (Revised)
• Feb 27 02 04:48p davie county envhealth 336 751 8786 p.2
i
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT 81 ATC F'Ce
Davie County Health Department
EnvironmentalHealth Section
r(j
P.O. Box 848/210 Hospital Street Oq��`%:��fT^ /
-/Mocksville, NC 27028 Fed '1 A%
(336) 751-8760 PC P 3 / y_o ...... /TAY
***II1PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED F
INFOR-MTION IS PROVIDED. jR�ef�e�jr�t-ofn-t%�h�e INFORMATION BULLETIN for instructions.
,/game to be Billed�lScDO,gj 0YllilC.r► o{ Ae- !"J ej)S1b/j Contact Person L9
�� n
C -'-'Hailing Address _le)3 FORK $ t x'3Y P -fl . Home Phone Wo ^ 3
—"eity/state/ZIP IRDVAOCZi , NC 2 +cn!;2_ Business Phone
Name on Permit/ATC if Different than Above1YlE _
Mailing Address '5* ME- City/State/Zip
✓3. Application ror: XSite Evaluation 0 Improvement Permit/ATC 0 Both
System to service: ❑ House 11 Mobile Home ❑ Business 0 Industry A Other C-12tlJ chL
L S If Residence: N People N Bedrooms I Bathrooms
H Dishwasher I..I Garbage Disposal II Washing Machine 0 Basement/Plumbingq II Basement/No Plumbing
6. If Business/Industry/Other: Specify type -a JRr—h1" # People 120 # Sinks 6
# Commodes 5_ A Showers ` N Urinals k Water Coolers I.
IF FOODSERVICE: ff Seats Estimated Water Usage (gallons per day)
Type of water supply: County/City ❑ Well 0 Community
__.a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQ IRED PROPEW Y INFORMATION REQUESTED
BELOW.ither a PLAT or SITE PLAN M ST BESU8M17TE by the client with THIS APPLICATION.
lam- Property Dimensions: 2. 90 AMS �-�E DIRECTIONS (from Mocksville) to PROPERTY:
577 7z - � t#S' ' '
x Office PIN: f .p -7,4� to'T /b
__Yxoperty Address: Road Name roRK •Dt1C$`� D .-blx3,-? A — L
Citylzip ,dam( �C' Z?�Llo -bAJ �
if iuhdivismn provide information, as follows:
Name: ^&k
pI.EASt: cot, wl"' 40104 FULLER
Section: Block: Lot: L/6atc Property Flagged: t? fuU.ER ARC141TecTu0,4L
151 -CA eco
This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site pians or intended use change, or if the information
submitted in this application is falsified or changed 1, also, understand that 1 am responsible for all charges incurred from
(his application. 1, 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 suuittaabbility.
DATE- Ze ,,�,
_/SIGNATURE /
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of ttie following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
i
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
7?000 p�J
Account No. -1 U 1
Invoice No. d Z
,r
GENEIZ
ALL DIMEP
PAVEMEN
ALL PAVE
D
wr E
APR 13 2004 yr,
EilliilRD VIEECOUWY�I
TION F011 SITE EMILUATION/Ih1P1I0MIENT 111:1018' a JVI-L'
Davie County Health Department
Enyiro1Jmenta/Hea/t/i Section
P.O. Box 848/210 Hospital Street
1locksville, PTC 27028
(336) 751-87(10
***IrSPORTANT*** TIiIS APPLICATION C1INNOT .02 PROCLSSZ'D UNLESS ALL ITEM REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inaLrucL-ions
1. Name to be Dilled
Mailing Address
City/State/ZIP
2. Namo on Permit/AT(
Mailing Address I
llauc Phone
llusiness Phonew!� l.._`!� �'......
3. Application For: ❑ Site Evaluation
2700
fX-Improvement Pcizuit/A`1'C ❑ 1loLli
4. System to Service: ❑ House ❑ 1101bile Home ❑ Business ❑ Industry ❑ Otllcl.-C�'�.�a
5. Type system requested: A Conventional ❑ conventional modified ❑ innovative
G. If Re3idence: It People It Bedrooms Il Dathroolu:, , 2
❑Dishwasher ❑Garbage Disposal ❑Washing Machine ❑Basement/Plumbingg ❑BasomonL/210 Plumbing
7. IL Business/
i
ndustry /other: verify type It People O 11 t inlcs . _
# Commodes '7— It Showers 2 11 Urinals li Watcr Cooluru
IF FOODSERVICE: fl: Seats Estimated Water Uc;agc (gallons per day). -
8. Type of water supply: ❑ County/City Well ❑ ColwauniLy
S. Do you anticipate additions or UpallSio115 of the facility tlliS S315tC111 iS illtellded LU Serve': Y,'L•S CI No
If)'rs,what type? tC�/c-�
***IA11'0R111N1'`** CLIENTS/)lUSTCOAII'LLTL•'TIIE llliQUIR 'D PRO1'LRTY INFORMATION I01-'Qt11SST1-'* )�
BELOW. liitllera PLAT orSITE PLAN i11USTBESUBA[177ED by the client �tii(b'!'II1S AI'PLIC�1'1'ION. I
5 171`rij;�llJinC115i0115:
J CTaxOffficcePIN:
Property Address: Road Nalllchak- Rxk
City/zip - yom cle- IJ_C•
If in a Subdivision provide infurnlation, as follows:
Nalllc:
WRITE DIRLCTIONS (IYum Muclisvillc) to I ROPI:k]'Y:
PV i>Z, Z %2! ods
Scc(ioll: Bloch: Lot: Datc home col•llcrs flagged: - 0
This is to certify that the hirormation provided is correct to the best of illy lulowledgc. I ullderstalld (lint any pennit(s)
issued hereafter arc subject to suspension or rcvocalloll, it the site plans 01- ill tended use cilallgc, ol- if tilc illfol'111:Itiull
subNlit(Cd ill this applica(iou is falsified or changed. 1, also, uurlerstaul dial! au! i-esponsible for all charges hlcun-ed f -our
I S applicadoa. I, hereby, give consent to the Authorized Representative of the Davie Cuwlty Ileal(ll I)cparinlcul
to alter upon above described property located in Davie County and owned by
to conduct al testing proccdur S 15 11CCCSSary to dClel'lnille (11C site suits lily.
DATE; � SIGNATURE
TIiIS AREA MAY BE USED FOR DRAWING YOUR SITE PL udc all of tllc following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Sign given
Site Revisit Ch:u'ge
Client Notification Date:
EIIS:
Account No. ( /
173
FORK
1 f
1 1 _.
1 �
�M,y� ! �MC�
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