224 Jarvis Rd3avie Countv.•NC ' Tax Parcel Report Friday. October 7, 201 E
WARNING:THIS 15 NOTA SURVEY
Parcel Information
Parcel Number:
F80000013406
Township:
Shady Grove
NCPIN Number:
5880464783
Municipality:
N1\ C
Account Number:
8301813
Census Tract:
37059-803
Listed Owner 1:
GEEZER GULCH LLC
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
587 IVY CIR
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
Legal Description:
7.626 AC OFF JARVIS RD
Fire Response District:
ADVANCE
Assessed Acreage:
7.63
Elementary School Zone:
SHADY GROVE
Deed Date:
1/2013
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009140191
Soil Types:
PaD,PcB2,PcC2
Plat Book: 11 Flood Zone:
Plat Page: 45 Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding 8r Extra 36770.00
Freatures Value:
Land Value: 61490.00 Total Market Value: 98260.00
Total Assessed Value: 98260.00
No
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Davie County,
All data is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
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or arising out of the use or Inability to use the GIS data provided by this website.
Account #: 990005964
Billed To: Andrew Hansen
Reference Narne:
Proposed Facility: Well
Davie County Environmental Health
P.O. Boa 848210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336)753-1680
WELL PERMIT
Tax:PIN'EH #: F800000134
Subdivision Info:
Location/Address: Jarvis Road -27006 .
Property Size: 6.26 Ac.
ATC Number: 0090 ?` ,
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there
has been a material change in any fact/circumstances upon which this permit was issued.
Permit Type: New ® Repair ❑ Abandonment ❑
Proposed Well Location
YL---(L2-,V
Certificate of Completion Diagram
r
Comments: KQe , �(�bIJ7 Driller:
Certification #:
Grout Inspected: I/ Z-% 20/,3
Well Head Inspected:
n GPS Coordinates: _ 5!S?l2 % .r) a ?YY7" f%
EHS: .r!_.l Pj1Walft,d Date:/O//&t/ EHS: Date:
W.P. 7-08
APPLICATION FOR PRIVATE WELL PERMIT
IV Davie County Environmental Health �(,�, ou ✓�
P.O. Box 848/210 Hospital Street 1 ` �� �✓�
Mocksville, NC 27028
p — (336)753-6780 / Fax (336)753-1680 '
IP ***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name A( W- #Ak5e-A) Contact Person
Address W CLO i ae-e- Home Phone 33� l7- a3a'f' CEu
City/State/ZIP %l E-Ik: e, N(ti ZZ006 Business Phone
Name on Permit if Different than Above
Mailing Address (/ 0 e- olvet t? ity/State/Zip
PROPERTY INFORMATION
NOTE: A survey
Owner's Name ,
*Date House/Facility Corners Flagged
site plan must accompany this application. Included: ❑ Site Plan ❑Plat (to scale)
Owner's Address _5f
Property Address 3;Z# F j_j— ,
Lot Size 9 Tax PIN#
Subdivision Name(if applicable)
Directions To Site: #WV kI/ C, t+?N o,v
U Ntxtf. (-r0p8r4y 0/l/ 1e4171t-f•
DEVELOPMENT INFORMATION
M
Phone Number
_City/State/Zip_ 27006
_City A4-1re,
F�0000a6 13yoS � �Ae
Section/Lot# '
Permit Type: New Well V Well Repair Well Abandonment Other (specify)
Facility Type: Residential Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES NO
Do You Intend To Install A New Septic Svstem On This Site? YES NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine the best location fo a well.
LArc , , J /U23 /z
Signed Date
7/30/09
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account # 5A(Pq
Invoice #
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720
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An data is provided as Is without wamnty or guarantee of any kind either expressed or implied inducting but not limited to the Implied
warranties of nerchantabildy or fitness for a particular use. Ag users of Davie County's GtS websde shag hold hannMss the County dU NS
Davie, "Orth carolma, its agenda, consultants, contractors or employees from any and an claims or causes of action due to or arising out Printed:Oct 23, 2012
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of the use or Inability to use the GIs data provided by this website.
'' + I V E APPLICATION FOR PRIVATE WELL PERMIT 5=0joZk fi P
Davie County Environmental Health
OCT 1 4 2011 P.O. Box 848/210 Hospital Street 14 t ` .; I { Eli f i A
Mocksville, NC 27028 ® D
BY: (336)753-6780 / Fax (336)753-1680 BY:
I r1-1
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name O E Contact Person1)ell
Address Home Phone
City/State/ZIPZ17
eo Business Phone
Name on Permit if Different than Above
Mailing Address Qf5W% � City/State/Zip
PROPERTY INFORMATION
NOTE: A survey plat r site plan
Owner's Name
Owner's Address
Property Addr,eIs.s
Lot Size 1�,1q
Subdivision Name(if applicable',
Directions To Site: � - -'/C7
*Date House/Facility Corners Flagged
accompany this application. Included: ❑ Site Plan ❑Plat (to scale)
JCA A, Phone Number
-"� City/State/Zip
ity/j 76ZV6
Tax P19# 3 G Ll
Section/Lot#
DEVELOPMENT INFORMATION
Permit Type: New Well ✓ Well Repair Well Abandonment Other (specify)
Facility Type: Residential Food Service Church Commercial Other n
Are There Any Septic Systems Currently On The Site? YES " NO
Do You Intend To Install A New Septic System On This Site? YES NO ✓
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine theSest location for a well. _,,o-
vacs l f g opooa t "3 Lt
7/30/09
�a-ice
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account # 1,319
Invoice # qq/z
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