138 Jerusalem AveDavie County, NC
Tax Parcel Report b Thursday, September 29, 2016
I j
126 ;
152 138
J.—
'14 6 i 13 0
112
108
205
Total Assessed Value: 17010.00
161
All data Is provided as Is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
CountyofDavie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
NCor arising out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
- Parcel Information
- -
Parcel Number:
M509000008
Township:
Jerusalem
NCPIN Number:
5745078443
Municipality:
Account Number:
53882000
Census Tract:
37059-807
Listed Owner 1:
NEWSOME LOLA
Voting Precinct:
COOLEEMEE
Mailing Address 1:
298 MOUNTAINVIEW DRIVE
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
DAVIE COUNTY CZOD
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
1 LOT JERUSALEM AV
Fire Response District:
COOLEEMEE
Assessed Acreage:
0.59
Elementary School Zone:
COOLEEMEE
Deed Date:
1/2016
Middle School Zone:
SOUTH DAVIE
Deed Book I Page:
010100648
Soil Types:
Gn132
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
0.00
Outbuilding & Extra
Freatures Value:
4510.00
Land Value:
12500.00
Total Market Value:
17010.00
Total Assessed Value: 17010.00
161
All data Is provided as Is without warranty or guarantee of any kind either expressed or implied including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
CountyofDavie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
NCor arising out of the use or Inability to use the GIS data provided by this website.
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' AUTHORIZATIONO: Q � Z AVIE COUNTY HEALTH DEPARTMENT
74 ed Environmental Health Section PROPERTY INFORMATION
Pert e' ~ ' /
* ,, + •, � P.O. Box 848
iw
Names
�� Mocksville,.NC 27028 a Subdivision Name:
Phone #: 704-634-8760
Directions to pr6perty. Sec ! Lot.
AUTHORIZATION FOR �"
WASTEWATER Tax Office PINI / = 0 #5
SYSTEM CONSTRUCTION 5 ?a
RoaQ Name• AM�ip: a boa S
**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 I I of G.S. Chapter 130Ai Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
,;. ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
J' - A IS VALID FOR A PERIOD OF FIVE YEARS.'
ENVIRONMENTAL HEALTH SP, CIAI Bf DATE ISSUED
i ,-. wya 1"Y FiSf'rr� ''`*�" •x.A�.,,il ,...✓.�..-. t �,,a'�,'eo i"�tt.i.i.,.,,`�'F ',...
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AVIE COUNTY HEALTH DEPAIfiTMENT
VEMENT AND OPERATION PERI�IITS PROPERTY INFORMATION
A
Name Q- _ Subdivision Name:
Ile lit
Directions to property: Secjj
Lot:
.�% IMPROVEMENT � ��, lr.,.
:PERMIT ' � Tax.Office PIN: r7"7
r - Road Name: sRZip: a Toa S
**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
,t 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)
-J ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
i
�f PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST^ DATE ISSUEDI ISYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS eg # BATHS _ # OCCUPANTS_ GARBAGE DISPOSAL: Yes or No
YA
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFI` # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE �REPAIR SITE,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH "`T �A ROCK DEPTH _iw LINEAR FT.
OTHER Alno
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**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.
SYSTEM INSTALLED BY:
lye_
AUTHORIZATION NO. OPERATION PERMIT BY: `Y DATE: V
**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)
1.
2.
APPLICATION FOR SITE EVALUATIONAMPROVEME
Davie County Health Department
Environmental Health Section
P. O. Box 848
Mocksville, NC 27028
(704) 634-8760
4
****IMPORTANT**** THIS APPLICATION CANNOT BE PR ESS
ALL THE ff UIRED INFORrgATION I ROVIDED. v
Name to be Billed Contact Person
OF
Mailing AddressCWJ Bhp =Home Phone _gQ��167 �f
City/State/Zip Business Phone
Name on Permit/ATC if ifferent than Abovec":M'
Mailing Addres ffy�' City/State/Zi_n%/ �1 �/
3. Application For:
❑ Site Evaluation ❑ Improvement Permit & ATC
❑ Both
4. System to Serve:
❑ House Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence:
# People # Bedrooms #
Bathrooms
j
❑ Dishwasher
El Garbage Disposal Q Washing Machine ❑ Basement/Plumbing ❑
Basement/No Plumbing
6. If Business/Other:
Specify type # People
# Sinks
# Commodes
# Showers # Urinals #
Water Coolers
If Foodservice:
# Seats Estimated Water Usage (gallons per day)
7. Type of water supply:
R--C"ounty/City ❑ Well
❑ Community
8. Do you anticipate
additions or expansions of the facility this system is intended to serve?
❑ Yes ❑ No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 4-Q g- `n"1 �J 1 WRITE DIRECTIONS (from
1 Mocksville) TO PROPERTY:
Tax Office PIN: # 'i ri q 5 - or_ - B y q 3 1
Property Address: Road Name 413,4 o *4 0 51621 P__� l tf1
City/Zip l3�/ eem e e �L/G
1
If in Subdivision provide information, as follows: 1
1
Name: 1
1
Section: Lot #: 1
1
1
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 Repre entative of the Davie
County Health Department to enter u n above described property located in Davie County
and owned by Z2yto conduct all testing procedures
as necessary) to determine the site suitability.
DATE / �o�' g / SIGNATURE
Revised DCHD (06-96)
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