4067 Hwy 158f
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Davie County Health Department
"(0 X18 _Icy Environmental Health Section `
P.O. Box 848
~ ,
&A V 210 Hospital Street
Q U'S Courier # : 09-40-06 1911
Mocksville, NC 27028
Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
r( (Check One) Replacement Remodeling Reconnection
Name: AQ_eTC2d toS Xmc_ Phone Number`x(o-Z'01 el$a
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Mailing Address: (,L/ � Pu , $/'i.J✓ 41 Y
L.Gz�Q y&ftA/u C L ] tfj Z Email Address: 1OlAi;j C6 7 to ,
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Detailed Directions To Site: -W' 40 ji¢,f/ /a RL -X,/ 17y %A�nniws7• ICd } �y crc �•a ivY.
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Property Address: qo (/ 7 hi uwy (Se 7 -
Please
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: % 46Type Of Facility:
Date System Installed (Month/Date/Year): l % 7 b Number Of Bedrooms: 3 Number Of People: d
Is The Facility Currently Vacant? Yes N If Yes, For How Long?
Any Known Problems? Yes To 10f es, Explain:
Please Fill In Te Fol/lowi g In or tion About The NEW Facility:
Type Of Facility: Q7i� c Number Of Bedrooms: Number of People
Pool Size: slGarage Size: E-n!9fl:J1 1/-3d Other:
[Requested By: Date Requested: ; r /
Signature)
For Environmental Health Office Use Only
pprove Disapproved
Comments:
Environmental Health Specialist
Date:
*The signing of this form by the Environmental Health Staffis 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 #.
Paid By
Received By:
Account #: 6_%7 V Invoice #:
ffi,0140
Parcel #: E600000079
Davie County, NC - Basic Estate Search
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Parcel #:E600000079 Account #:62516000
Owner Information
Building:
Tax Codes
BXF:
TEN JERRY FRANK & ROTEN NANCY L
100CICKSVILLE,
Land:
ADVLTAX - COUNTY TA
Market:
7 US HIGHWAY 158
ssessed:
FIREADVLTAX - FIRE TAXNC
Deferred:
27028
Property Information
Township
nd (Units/Type): 2.580
FARMINGTON
ddress: 4067 US HWY 158
Deed Information
Local tonin
Date: 05/1976 Book: 00098 Page: 0581
Plat Book: Page:
Le al Description
PIN
58 AC HWY 158
62516000
ProveProvertv Values
Building:
9112
BXF:
19,04(
Land:
40,91C
Market:
151,07(
ssessed:
151 07
Deferred:
01
Sales Information
No Sales Data found.
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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Davie County Web Site
All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be
consulted for verification of the information. All Information contained herein was created for the Davie County's internal use. Davie County,
its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
Implied, in fact or in law, Including without limitation the implied warranties of merchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnettView.aspx?prid=1458677 6/8/2016