235 Leisure Ln Davie County,NC Tax Parcel Report Friday, December 9, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: B300000090 Township: Clarksville
NCPIN Number: 5813685013 Municipality:
Account Number: 7'82529409 Census Tract: 37059-801
Listed Owner DILLARD SCOTTY TYRONE Voting Precinct: CLARKSVILLE
Mailing Address 1: P 0 BOX 82.: Planning Jurisdiction: Davie County
City: MOCKSVILLE- Zoning Class: DAVIE COUNTY R-A
State:. NC Zoning Overlay:
ZIp_Code:_-'--- 27028-0000 Voluntary Ag.District: No
Legal Description: 1.000 AC LEISURE LN Fire Response District: COURTNEY
Assessed Acreage: .1.00 Elementary School Zone: WILLIAM R DAVIE
-.Deed Date: 3/2008 Middle School Zone: NORTH DAVIE
Deed Book/Page: 007510581 Soil Types: MdC,MdE
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
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
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
DUN NC or arising out of the use or Inability to use the GIS data provided by this website.
=4 HEALTH DEPARTMENT RELEASE For Office UseOnly
*CDP File Number 231104- 1
4*4 Davie County Health Department 5813685013
tsf.
210 Hospital Street County ID Number.
' P.O. Box 848
Evaluated For. NEW
Mocksville NC 27028
- -- Phone:336-753-6780 Fax-336-753-1680 PERMIT VALID 1 1 / 1 5 / a 0 1 6
_ _... UNTIL
Applicant: Scotty Dillard Property Owner: Scotty Dillard
Address: PO Box 82 Address: PO Box 82
City: Mocksville City: Mocksville
-State0p: NC 27028 State/Zip: NC 27028
_ =Phone M (336) 705-6024: Phone#: (336) 705-6024
Property Location&Site Information
-
rAddress235 Leisure Lane Subdivision: Phase: Lot
oad# Mocksville _._.._._ NC 27028truGure:
SINGLE FAMILY Township:
Directions
3 p ' 4 h 601 North,left on County Home Rd.right on Leisure Lane
#of Bedrooms: #of Peo le: WY 9
'Water Supply: NIA
I
Basement:'❑Yes F]No Type of Business:
Total sq. Footage: No.Of Employees:
*Proposed Improvement:
'Release Conditions e
r
New home must be a minimum of 5 foot from the existing septic system:,If fall cannot be met to existing septic tank,a pump must be
Installed.
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps.Signature Required? OYes ONO
Applicant/Legal Reps.Signature,• *Date:
*Issued By- . 2140-Nations,Robert *Date of Issue:_ 1 1 1 5 .2 0 1 6
Authorized State Agen
**Site Plan/Drawing attached.**
@Hand Drawing Olmport Drawing
HEALTH DEPARTMENT RELEASE 231104"= 1
ew Davie County Health Department CDP File Number:
210 Hospital Street 5813685013
P.O.Box Bas County File Number:
-Mocksville NC 27028 Date: 1 1 / 1 5 / a 0 1 6
0Inch
Scale: OBiock — ,ft.
Drawing Type: Health Department Release ON/A
_ <:
17,z)
_ I
. ...................
1-7
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Page2of2 __� � __
F
C Yv�'ID Davie Count},- Health Department t
4�16j nvironmental Health Section .
2 P.O.Box 818
210 Hos iud Street
Q U � Courier# : 09-40-06
Mocksville,NC 27028
t:.
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
0 '���
Name: � Phone Number W(7`'1(Home)2 �Q
Mailing Address: Zi ",, Q� t)C ) (`Vork)
C- coag
Detailed 4?f-su(&&0Directio MQs To Site: (!!G` �r o/o � /(�
Property Address: Z?�� ,lit �i a �fl�. I�l(1C'�C" ��1��F N—)C-- 02_-)
Please Fill In The Following Information About
The EMSTIYG Facility: I 1
Name System Installed Under: Type Of Facility: MChNo
JJ i
Date System Installed(Month/Date/Year):,'P UO.L1. Number Of Bedrooms-,Number Of People:
Is The Facility Currently Vacant? Yes No If Yes,For How Long?
Any Known Problems? Yes CNo) If Yes,Explain:
Please Fill In The Following Information About The NEW Facility: ?S�
Type Of Facility:��_ �� u.�t� Number Of Bedrooms: y Number of People "1
Pool Size: c -Gig7ge Size: Other:.
Requested By: l Date Requested: [0•I Z L�
(Sig re)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*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.
Pay Cash heck Money Order # Amount:$ZQ •C)o Date:
Paid By: ( Received By:
Account#: d 3 /ld I Invoice
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