1675 Hwy 801SDavie County, NC , ., Tax Parcel Report Wednesday, October 12, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: G8050A0004 Township: Shady Grove
NCPIN Number: 5880212663 Municipality:
Account Number: 298750 Census Tract: 37059-804
Listed Owner 1: ADVANCE UNITED METHODIST CHURC Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 1675 NC HIGHWAY 801 SOUTH Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag. District: No
Legal Description: 6.71 AC HWY 801 Fire Response District: ADVANCE
Assessed Acreage: 6.87 Elementary School Zone: SHADY GROVE
Deed Date: 9/2004 Middle School Zone: WILLIAM ELLIS
Deed Book / Page: 005710479 Soil Types: WeB,PcB2
Plat Book: 0003 Flood Zone:
Plat Page: 070 Watershed Overlay: DAVIE COUNTY
Building Value: 971530.00 Outbuilding 8� Extra 0.00
Freatures Value:
Land Value: 96100.00 Total Market Value: 1067630.00
Total Assessed Value: 1067630.00
9"�'F Davie County,
�aU��� NC
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AUTHORIZATION�NO: 'O J�'j 6 AVIE COUNTY HEALTH DEPARTMENT �'' �,r �^ ^� 5p, {�� ,
' � Environmental Health Section PROPERTY INFORMATION I�'�b
Permittee's c ,� P.O. Box 848
Name:;�a�v �t1�c� '��*r���::�� \��*.� `a��.�y-,..`"_*,� �;'Mocksville, NC 27028 Subdivision Name: '
1 Phone #: 704-634-8760
Directions to property: 1�'S `� �-• ���l �^� � r Section: Lot:
- AUTHORIZATION FOR
`�� `� "` �, `�` WASTEWATER
��`, �� , � C�t ��`�`'`''�"', �`� �'�� ��� ��'��' SYSTEM CONSTRUCTION Tax Office PIN:# - -
Road Name: V���::-�_�.;+:..n �' y Zip: �� ���'
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts. "
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Trea[ment and Disposal Systems)
;`�* C� a�, � C;�,w �,,. c� �'�j ***NOTICE*** T'HIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
� �.-��.i-==*-� '`-� �• � 1� '-' f IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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` �. .,�,. X�� � � IMPROVEMENT AND OPERATION PERMITS PRO .ERTY INFORMATION � ' ��
Permlttee', s -� � � , '
- Name:<< � ti �.., - � � . ' '� _ . ' .::t _
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- 'Di��ctic�ns to property: i ' `� ��a '
;�`�1 t�' -""''-,..� � IMPROVEMENT
PERNIIT
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Subdivision Name:
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Section: Lot:
Tax Office PIN:#
Road Name: � �� t_ ,:� ZIP, �•� i' i•;'' , �
�**NOTE** This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCITON must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut. '�, i �
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal'Systems)
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ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE�j���'�`� # BEDROOMS
COMMERCIAL SPECIFICATION: FACILITY TYPE
LOT S J � � TYPE WATER SUPPLY �
# PEOPLE
***NOTICE*** THIS PERMIT 1S SUBJECT TO REVOCATION IF SITE
PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE TEIIS PERNIIT BEFORE
INSTALLING TI� SYSTEM.
� # BATHS # OCCUPANTS i GARBAGE DISPOSAL: Yes o No
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_# PEOPLFJSHIFf # SEATS INDUSTRIAL WASTE: Yes or No
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1�ESIGN WASTEWATER FLOW (GPD) ��^ l U NEW SITE �� REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH .� r�'"+ LINEAR FT. ti�a
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REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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**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 # IS (704) 634-8760.
I OPERATION PERMIT
AUTHORIZATION NO.v� � �
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**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 OS/96 (Revised)
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� �DAVIE COUNTY HEALTH DEPARTMENT '
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Permittee's � , ' 3 '
_ Nat�e'` _ . � Subdivision Name:
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' �Directions to property: ' � Section: Lot:
f_ t ; . IlVIPROVEMENT
r, �'"' -�... ��. ,. ., PERMIT Tax Office PIN:#
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_ Road Name: . ': Zip: ....., s � -
**NOTE** This Improvement Petmit DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AITTHORIZATiON FOR WASTEWATER SYSTEM CONSTRUC'TION must be obtained from this Department prior to the
constcuction/installation of a system or the issuance of a building pemut. .,.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
�.4 � .: **�'NOTICE**"' TfII.S PERNIIT IS SUBJECT TO REVOCATION IF STl'E
�, i� PLANS OR TI� IlVTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING Tf� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDINC3 TYPE�� Q V�'� # BEDROOMS '=� # BATHS # OCCUPANTS '� (3ARB?iGE DISPOSAL: Yes o�No
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COMMERCIAL SPECIFICATiON: FACILITY TYPE # PEOPLE # PEOPLFlSHIFf # SEATS I�iDUSTRIAL WASTE: Yes or No
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LOT SIZE� ^ ��� TYPE WATER SUPPLY `-1� DF�SIGN WASTEWATER FLOW (GPD) =` j�U .i NEW SITE � REPAIR SITE t��
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SYSTEM SP�C��ICATIOIVS; TANK SIZ� C3AL. PUMP TANK GAL. TRENCH WIDTH % ROCK DEPTH �--� LINEAR FI'. ��n
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�QUIR�� SI'PE MA�I�ICATIONS/CON�ITtONS: _.
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IMPROV�M�N'P �RMIi' LAYOUT
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�*��N`PA�`f' A����IVTA`�IV� @� `fti� �AVI� COUNTY HEALTH DEPARTMENT FOR FINAL INSPECCiON OF THIS SYSTEM
��`PVV��N �t�0 =�t�0 A.M, 0� 1;00 • 1t�0 P,M, ON THE DAY OF INSTALLATION. TELEPHONE li IS (704) 634-8760.
���A�'I�N F��INI`P
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a►urxo�►�nox tvoJ� � o�Rn�o:. .
**Tl°[E ISSUANC� OF TkIIS O�RATlON PERMIT SFiALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTtCL� 11 0� C3.S. C�tAP'i�R 130A, SECTION .1900 "SEWAC3E TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
(3UARANTE� TFiAT TFi� SYSTEM W1LL FUNCTlON SATISFACTORILY FOR ANY C3IVEN PERIOD OF TIME.
DCHD 03/86 (Aevleed)
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ADDRES
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DIRECTIONS
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �Y�fy�
APPLICATION FOR IMPROVEMENT PER T(REPAIR) �%�" �/�'fI'�1�
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BDIVISION NAME
LOT #
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DATE SYSTEM INSTALLED `�U • NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS � NUMBER PEO LE SERVED�
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
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DATE REQUESTED �'�l �� INFORMATION TAKEN BY
Thia is to certify that the information provided is correct to the best of my knowledge, and ��i yr�e
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
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I am rd�consihle for all
application.