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2076 Hwy 601Shis O U tk'S )avie County Health Department Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 1911 w,r_ _i___ *n wT." nnnnn ` Phone: (336) - 753 - 6780 rOT -WA5fiL R CERTIFICATION Fax: (336) - 753-1680 (Cplacement Rel'C6_ Reconnection I Name: C� Q S `. � 7 one Number 0 p (Home) Mailing Address: tt 1 l �� 3��D " -75 3 '13 � (work) C • P_ Email Address: 0 /1 (1 C -Q, Detailed Directions To Site: Ino 1 'e S6 `tA A7� YC" (�(�)hl P P wu f (_lit P_ F' h 4- N 0 -,4 4 Property Address: -a. V'� (_P kA -P i n• c a 7cS a �s Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under:( (' C 1 I Type Of Facility:�•j�Q,lt (a Date System Installed (Month/Date/Year): C� CXR 07. Number Of Bedrooms: L\l�Number Of People: Is The Facility Currently Vacant?( Yes) No If Yes, For How Long? N! aAt> Any Known Problems? Yes If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: 1(t A_� Number Of Bedrooms: Number of People Pool Size: l Garage Size: Other: Requested By: Cil.[ X ,�? 1 ( `7 f Date Requested: mature) For Environmental Health Office Use Only Approved isapproved Comments: 10 i 7 Environmental Health Specialist Date:,,,? 1-3 *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 #: } Appraisal Card Page 1 of 1 2/19/2013 9:22:52 AM LUS FRED O Retum/Appeal Notes: LS -070 -AO -029 126 GLADSTONE RD UNIQ ID 21927 4073500 FRIENDLY CEN.GRO.D330P5 ID NO: 5746069360 COUNTY TAX (100), FIRE TAX (100) CARD NO. I of 1 eval Year: 2013 Tax Year: 2013 4.02 ac Gladestone Rd 4.020 AC - 4.020 AC SRC- Ised by 55 on 10102/2008 05005 GLADSTONE TW -05 C- EX- AT- LAST ACTION 20110712 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 4 EOB I Economic 0.1000 read Footing 6.00 Eff. BASE bsolescence I Standard 0.6600 ub Floor System - 2 lab on Grade-Residential/Commercial 6.0 USE MOCArea QUAL RATE RCN EYB AYB CREDENCE TO MARKET xterlor Walls - 11 16 07 12 30 78 53.82 6236 198 197 % GOOD 24.0 DEPR. BUILDING VALUE - CARD 158 97 TYPE: Shopping Center -Strip Commercial DEPR. OS/XF VALUE - CARD 4,86 MARKET LAND VALUE - CARD 123,33 oncrete Block 18.0c, ooting Structure - 09 I id Frame w Bar Joist I0.0C STORIES: 1 - 1.0 Story TOTAL MARKET VALUE - CARD 287,16 Doting Cover - 04 ilt Up Tar and Gravel 4.0 OTAL APPRAISED VALUE -CARD 287,16 ntenor Wall Construction - 1 ason or Minimum 2.00 TOTAL APPRAISED VALUE - PARCEL 287,16 nterlor Floor Cover - 03 ncrete Finished 1.0 OTAL PRESENT USE VALUE - PARCEL eating Fuel - 02 ood or Coal 0.0 OTAL VALUE DEFERRED - PARCEL OTAL TAXABLE VALUE - PARCEL 287,16 g Type - 04 Air - Ducted 6.0 1 BAS I PRIOR 1 Il VALUE 238,45ercial nditioning Type - 03 6.0 I IUILDING BXF VALUE 24,30 ND VALUE 123,33ural Heat &Air - 1 0.0 I I RESENT USE VALUE I EFERRED VALUEI Frame - 04 [en, 12.0 I OTAL VALUE 386 08 I I & Insulation - 03 nded - Cellin and Wall Insulated 7.0 9e 0a Rooms Per Floor - 3 Rooms Per Floor 0.0 Iing I 1 PERMIT Fixtures 3.00 1 2 CODE DATE NOTE NUMBER AMOUNT I 4 I I I 1 OUT: WTRSHD: I I SALES DATA I I FF. INDICATE + - 15-+ 1 I F O F I 1 ECORD ATE DEED SALES ITYPE L POINT VALUE kii.00C BUILDING ADJUSTMENTS Size 3 Size.960 uali 3 AVG 1.000 Shape/Desig 21 FACTOR 2 1.000 OTAL ADJUSTMENT FACTOR 0.96 I oo AGE R JIW PRICE OTAL QUALITY INDEX 7f I I I 0095 310 3 11W7 WD X V 3 3 I 2 2 I I i I I I 1 +-15-+------------93------------+ BUILDING AREA 12,012 6 F O P 6 NOTES ------------- 93-------___--+ bo per plat 20113 STORES h -SEE INCOME APPROACH SUBAREA UNIT ORIG % ANN DEP % OB/XF DEP GS ODE ESCRIPTIO LT NIT PRICE GOND BLDG B AYB EYB RATE V GOND VALUE P PAVING 12 270132,40013.0 30 L 1977119941 S 486 AREA % RPL CS 9 11 53 10 62065 OTAL OB XF VALUE 4 8648 EAS 11 2970 55 41 1200 REPLACE I - None UBAREA 12,57 2,36 OTALS UILDING DIMENSIONS BAS=W93S90FOF.WISS32E15N32 534FOP=S6E93N6W93 E93N124 . NO INFORMATION OTHER ADJUSTMENTS LAND IGHEST AND USE LOCAL FRON DEPTH/ LND COND AND NOTES RDA UNIT TOTAL LAND NTLTOTAL, ADJUSTED EST USE CODE ZONING TAGE EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYPUNIT PRICE OMMERCIAL tVALUENOTE 0700 620 0 1.0000 0 1.0000 1.0 104544.00 SF 1.0URALAC 0120 0 0 1.9260 4 1.0200 SO +12 +00 +00 +00 PW 5,900.0 1.62 AC11,593.5OTAL MARKET LAND DATA 1.62 f TOTAL PRESENT USE DATA I 1 I I I http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=L507OA0029 2/19/2013 mittee Pers / DAVIE COUNTY HEALTH DEPARTME Name:. ` �' Environmental Health Section PROPERTY INFORMAT r P.O. Box 848" ' Directions to roe f +`t ':) f� , O P P rty �� Mocksville, NC 27028 Subdivision Name: ✓/ t / Phone #: 336-751-8760 % '`. t r"`," i ` f' Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 002597 A Road Name: Zip: **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 FormJAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I I of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ii' •' . ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ' IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE _kZ# PEOPLE # PEOPLE/SHIFT --/— # SEATS` INDUSTRIAL WASTE: Yes or Nc LOT SIZE TYPE WATER SUPPLY 4 v DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT PL, �, FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. /06�PERATION PERMIT 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 SATISFFAAJCpT►ORILQyY FOR ANY GIVEN PERIOD OF TIME. / ncHn 02102 (Revised) a / •y =nY �''�g; � Y ./Rw,{ .! .:-.N � (`-� U r,, .E~/v� l////J//j///•J//'/�///�� + 1,-� �' J '!f � ! � jf • i • t � t �/ j// 1 / WIO• r� ., .: errluttee s ,. ` �/�` DAVIE COUNTY:HEALTH DEPARTMENT' 1(�/VI f ((J '/7. Nam Environmental Health Section PROPERTY INFORMAT PY P.O. `Box 848 ' Directiontti'property: "`•° Mocksvl]e, NC 27028. Subdivision Name:' -, r, f Phone #:.336751-8760 I Section: Lot: B AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - 042597 A AUTHORIZATION NO: Road Name: Zip: **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 1 I 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 RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE/"r# PEOPLE 1� # PEOPLE/SHIFT _,/_ # SEATS --S +INDUSTRIAL WASTE: Yes'or No i7 LOT SIZE TYPE WATER SUPPLY" DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE +'� 4 , SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK 'GAL. TRENCH WIDTH � ROCK DEPTH % LINEAR FT. �GV OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: V AUTHORIZATION NO. ` PERATION PERMIT 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 02102 (Revised) �� - ry 0 0 i t � e+ e r t+r"..,�,� ..,�„r��.i r'J1?"H"'1�`q' c'vy�° N '� ��' r+� �, i n x� :. a 6 "..w r � 9 �< ' )�1...��.• .t.. i � � '`.�• �''L :,�,r.a.�.' .. . ,' . } v .�``4 `•.a,r ,) ;�r+ �'r!� i�,,,,, y. .}.' r wt� t w.. ' Q�:�� +► G�J'Y3��o I -��,�;` AUTi�QRIZATION,NO: �<� �j ��DAVIE COUNTY HEALTH DEPARTMENT =��- , �,� ��,.� ' Environmental Health Section PROPERTY INFORMATION Permittee'� `, � ,,� � ��%T't.-� +� P.O. Box 848 � f � . : �'`/ �-O a- �:Name: - ...'��,',.(' � 5 Mocksville, NC 27028 Subdivision Name: --.;. : � - � ' �'" �Phone # '336-751-8760 . , `birections to property:1�%' " _ . J ` � , , Sectton:' `, Lot: AUTHORIZATION FOR , � � : WASTEWATER •-> Tax Office PIN:# - , , , , . , SYSTF.M CONSTRUCTION Road Name: .� Zip; **NOTE**,This Authorization for Wastewater $ystem Construction MUST BE ISSUED by the Davie County vironmental Health Section prior ,�, } ta issuance of any Building-Rermits: This Form/Authonzation Number should be presented to the Davie County;Building Inspections ' ; Office when applying for Building Pertnits �. '� (In compliance wi[h Article I 1 of G.S: Chapfer 7 30A, Wastewater Systems Section�: t900 Sewage Treatment and Disposal Systems) - ***NOTICE*** TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION '' ~�1�--' ' ��C�p'� . IS VALm FOR A PERIOD OF FIVE YEARS.' .� E ENTAL HEALTH SPECIALIST �, DATE IS UED : . �:.: - . _ DCHD 05/96 (Revised) r ' s DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME ^R PHONE NUMBER ADDRESS 4,5S SUBDIVISION NAME LOT # DIRECTIONS TO SITE S '7i C4 --S DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPJJCATION FOR IMPROVEMENT PERMIT (REPAIR) NAME i PHONE NUMBER ADD DIRECTIONS TO UBDIVISION NAME DATE SYSTEM INSTA D / 0 AME SYSTEM INSTALLED UNDER ALP 1` TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED AVV161,�I FORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 Parcel #: L507OA0029 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search 0 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:L5070A0029 Account #:24073500 Owner Information Building: Tax Codes BXF: LIS FRED O IOLOOLEEMEE, Land: ADVLTAX - COUNTYTBOX Market: 1018 ssessed: FIREADVLTAX - FIRE TAXNC Deferred: 27014 Property Information Township Land (Units/Type): 4.020 AC JERUSALEM Address: 126 GLADSTONE RD Deed Information Local tonin Date: 03/1975 Book: 00095 Page: 0310 Plat Book: 10 Page: 398 Le al Description PIN 02 ac Gladestone Rd 5746069360 Property Values Building: 158 97 BXF: 4,86( Land: 123,33( Market: 287,16( ssessed: 287,16( Deferred: Sales Information No. Book Paye Month Year Instrument Qual/UnQual Improved Price 00095 0310 03 1975 WD Unqualified Vacant 0 View Property Record for this Parcel .View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP�f� urill 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/itsnet/View.aspx?prid=1472393 8/2/2016