4265 Hwy 158 r _ �'� ►
a _ Davi unty Health Department
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En on ental Health Section
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P.O. Box 818 �' M
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210 Hospital Street `
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Courier# 09-40-06
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Mocksville, NC 27028 \2A
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
Name: nl�=� ��(S Phone Number (Home)
Mailing Address: (vW 5 1 (Work)
Detailed Directions To Site:
Property Address: Pw_l 1'N
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility:&k7n9.sS
Date System Installed(Month/Date/Year): Number Of Bedrooms:N� Number Of People:
Is The Facility Currently Vacant? YesNo If Yes,For How Long?
Any Known Problems? Yes No If Yes,Explain:
Please Fill In The Following Information About The NEW Facility:, FS 15•5 X ��
Type Of Facility: Number Of Bedrooms: _Number of People
Requested B a-5 Date Requested:
(S gnature)
For Environmental Health Office Use Only
��p�4ve Disapproved
Comments: �/'//$ eneZIZ40: //�
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Environmental Health Specialist 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.
Payment: Cash Check Money Order # Amount.$ IQQ.d0 Date:
Paid By: Received By:
Account#: Invoice#:
(A)i h ./U!� �.►eis (,gill �lAil 1P .
Parcel#: E70,00000a 0 Page 1 of 1
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Davie County.. NC - Basic Estate Search ®rj -
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Parcel#: E700000010 Account#:69321000
Owner Information Tax Codes
OWERS DONALD RAY&SOWERS BRENDA M ADVLTAX-COUNTY TA
91 LENALAN DRIVE READVLTAX-FIRE TAX
EXINGTON NC 27292
Property Information Township
Land (Units/Type): 14.040 AC FARMINGTON
ddress:4265 US HWY 158
Deed Information Local Zonin
ate: 11/1992 Book: 00116 Page: 0092
lat Book:
age:
Legal Description PIN
14.04 AC HWY 158 5861273920
Property Values
Building: 408,76
BXF: 28,80
Land: 280,80
Market: 718 36
ssessed• 718,36
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00111 0845 02 1988 WD Unqualified Improved 110,000
00116 0092 it 1992 WD Unqualified Vacant 135,000
00137 0812 06 1987 WD Qualified Improved 110,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1474782 6/14/2016