1189 Jericho Church RdDavie County, NC
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Tax Parcel Report
U I Monday, October 10, 2016
WARNING: THIS IS NUT A SURVEY
Parcel Information
Parcel Number:
J40000003602
Township:
Mocksville
NCPIN Number:
5737481032
Municipality:
MOCKSVILLE
Account Number:
82519086
Census Tract:
37059-806
Listed Owner 1:
CUDD DENNIS
Voting Precinct:
SOUTH MOCKSVILLE
Mailing Address 1:
1189 JERICHO CHURCH ROAD
Planning Jurisdiction:
MOCKSVILLE
City: MOCKSVILLE
Zoning Class:
MOCKSVILLE GR
State:
NC
Zoning Overlay:
Zip Code:
27028-4124
Voluntary Ag. District:
No
Legal Description:
1.82 AC JERICHO CHURCH RD
Fire Response District:
MOCKSVILLE
Assessed Acreage:
1.83
Elementary School Zone: MOCKSVILLE
Deed Date:
6/2002
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
004260530
Soil Types:
WeC,WeB,RnD
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
MOCKSVILLE
Building Value:
114500.00
Outbuilding & Extra
0.00
Freatures Value:
Land Value:
25000.00
Total Market Value:
139500.00
Total Assessed Value:
139500.00
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
NC
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
or arising out of the use or Inability to use the GIS data provided by this website.
AUTHORIZATION NO: 0571 DAVIE COUNTY HEALTH DEPARTMENT i/X a
Environmental Health Section PROPERTY INFORMATION
Na
Permittee,
ermittee s/;
ll i. P.O. Box 848
me: �'� �w( r Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760
Dircctions to property: '""�rJ' ' f' �� ` Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
" � i �ci.
Roil Na e: �.1� 1 10 o�1. p: / Uric+ ,
**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)
ENVIRONMENTAL HEALTH SPECIALIST
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
DATE ISSUED
DAVIE COUNTY HEALTH DEPA�tTMNT
IMPROVEMENT AND OPERATION PERMITS
Dame:
Directions to property:
PROPERTY INFORMATION
Subdivision Name:
Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
I I ',, 1 ; -: 1
Road Name: J 1- I ,—'l � .11. Zip: 1
Vi0
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***mnTtry*** TNiC PFBMiT iC .4QiTnrv.rT Tn RrvnrATION iF CiTF.
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE // # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE TC # PEOPLE # PEOPLE/SHIFT -,;?— # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY J DESIGN WASTEWATER FLOW (GPD) NEW SITE �`""�'� REPAIR SITE F/
SYSTEM SPECIFICATIONS: TANK SIZE/G' iy GAL. PUM7P' TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
n rcrcn /,,7h;, �] /d
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
"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.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. - OPERATION PERMIT BY: ��%`�� DATE: 111-11141-"
"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 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department n�
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028 P�
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed
Mailing Address
City/State/Zip Vz Jf e, k) C�
2. Name on Permit/ATC if Different than Above
Mailing Address
Contact Person A5—,VA)). Cc-
Home Phone Ce3l-a.? 3 i?
Business Phone
City/State/Zip
3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC [ ] Both
4. System to Serve: [ ] House [ ] Mobile Home [-4"Business [ ] Industry [ ] Other
5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal
[ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks
# Showers # Urinals # Water Coolers
1'J"
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: [vKcounty/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes
If yes, what type?
# Commodes
[ ] No
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A FLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: _
Tax Office PIN: #.
Property Address: Road Name
City/Zip
If in Subdivision provide information, as follows:
Name
Section: Lot #:
WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are
subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or
changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized
Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned
by to co uct all testing proce res as necessary to determine the site suitability.
DATE SIGNATURE���
Revised DCHD (06-96)
-k 0 * 9 ;!� <0 A -) e-,
OD
f DAVIE COUNTY HEALTH DEPARTMENT I/)(b
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systerils Permit Number
Name r°11rLs � � 1 Gy Date /T*-% -2?L N° 7 6 8 8
Location
.;�Subdivision'Name Lot No. Sec. or Block No.
Lot Size_ House Mobile Home --Business -- Industry
No. Bedrooms. No. Baths No. in Family �_— Public Assembly Other
Garbage Disposal . YES p NO 2`}
Specifications for System:
Auto Dish Washer YESNO
� �
.Auto Wash Ma thine YES NO p ,
Type Water Supply
ti. This permite.Void if sewage system descr' low not in lied W6 5 years from date of issue.
This permit is subject to revocation if i a or_V a inte ed use ha
/
Improvements permit by
"Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion Date
The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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' �� DAVIE COUNTY HEALTH DEPARTMENT ��.�_
IMPROVEMENTS PERMIT AND CERTIFICATE--OF COMPLETION � /�a-3/-9SF-�-
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a W'�'�
nitary Sewage Syste,ms Permit Number�� �
/ / "'.: � -7^�T
Name i C < ��;��I' ._s�� G�l. 5��, s`�i1r Date4 /G'" � `�.Y N� . I ! �� ��'.
, . ,
�
, , �
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Location �� ` '.' S ��"� / ,� r l' .�-f/.�.�i� _ . ��" Q�,
�. r ,, 1 ,,�' " ld
Subdivision Name Lot No. Sec. or Block No.
f�` :
Lot Size�_��r House �Mobile Home _ Business _- Industry _
No.Bedrooms �_.No. Baths _�_ No. in Family�.__ Public Assembly Other
Garbage Disposal YES p NO [.�'" Specifications for System:
Auto Dish Washer YES p: NO [.j�
� `
Auto Wash Ma^hine YES p NO [�'' ����`�' �? �,-�,.
�
� Type Water Supply _ � ___
,/G��'�,�i.� — ,�- ,�'
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change. •
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Improvements permit by _—� ..�
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' *Contact a representative of the Davie Counry Health Department for final inspection of this.system between 8:30-9:30 A.M , '
1:00-1:30 P.M.or 4:30-5:00 P.M..on day of completion.Telephone Number:704-634-5985.
Final lnstallation Diagram: System Installed by �
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, Certificate of Com letion __��` � ' Date '�� �`
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� 'The signing of this certificate shall indicate that the system described above has been installed in compliance with.'
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.