4347 Hwy 158 (2) �avie County, NC Tax Parcel Report Monday, October 3, 201 f
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WARNING: THIS IS NOT A SURVEY
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�y,_y _ Parcel Information
Parcel Number: E700000033 Township: Farmington
NCPIN Number: .-_ 5861382199 Municipality:
Account Number: 8301365 Census Tract: 37059-802
Listed Owner 1: TRINITY ONE INVESTMENTS LLC Voting Precinct: SMITH GROVE
Mailing Address 1: 7980 VALLEY VIEW DRIVE Planning Jurisdiction: Davie County
City: CLEMMONS Zoning Class: DAVIE COUNTY H-B,R-20
State: NC Zoning Overiay: DAVIE COUNTY QD
Zip Code: 27012 Voluntary Ag. District: No
Legal Description: 3.314 AC HWY 158 Fire Response District: SMITH GROVE
Assessed Acreage: 3.13 Elementary School Zone: PINEBROOK
Deed Date: 9/2012 Middle School Zone: NORTH DAVIE
Deed Book/Page: 009011023 Soil Types: Gn62
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 14100.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 136780.00 Total Market Value: 150880.00
Total Assessed Value: 150880.00
��/ All data Is provided as Is without warranty or guarantee oi any kind elther expressed or implied Including but not Ilmlted to the
9'fl�b�' Davie County� implled warranties oi merchantabllity or fltness for a particular use.All users oi Davie County's GIS website shall hold hartnless the
7�� County of Davie,North Carolina,its agents,consultants,contrectors or employees from any and all claims or eauses of actlon due to
�'OUN�t� 1\C or arising out of the use or Inability to use the GIS data provided by this website.
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Davie County Health Department
��i�f� ��� Environmental Health Section ���_F_� , ����� �
� ���. P.o. BoX s�s �
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�, ';5,, 210 Hospital Street � ��,!� �; . '
O U, ,�� ' Courier# : 09-40-06 ����
Mocksville, NC 27028 �
Phone:(336)-753-6780 ras:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
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Name: ��'/�t/ ./ �����'� � honeNumber ��� "���7�,�5 (Home)
Mailing Address: (/ �Gt/��j`,.,Y> (Work)
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C''/l�! S Email Address:J�,,���/��7��c, �C�r��`p�
Detailed Directions To Site: C
�Ol�di/{ d � � -P iv�
Property Address: � � �/��,/C�
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility:
Date System Installed(Month/Date/Year): Number Of Bedrooms:_�Number Of People:
Is The Facility Currently Vacant Ye No If Yes,For How Long? �
Any Known Problems? Yes No If Yes,Explain:
Please Fill In The Following Information About The NEW Facility
,,[ 1'? 5lr"�c_'�5
Type Of Facility. C�P V S/O/'� Number Of Bedrooms: Number of People
Pool Size: '✓ Garage Size: `�✓ � Other:
�
Requested By: Date Requested: `7 0� .s
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
, �
Comments: � � Q��f ^ � � Q S �,�/ \� �u Q -1 Y �Q
� ��a✓r Pr/
Environmental Health Specialist Date: 7'�/ �5
*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:$ Date: � �'��
Paid By: Received By:
Account#: Invoice#:
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