1581 Liberty Church Rd Davie County,NC Tax Parcel Report Monday, October 3, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: C20000003401 Township: Clarksville
NCPIN Number: 5812197009 Municipality:
Account Number: 13277500 Census Tract: 37059-801
Listed Owner 1: CARTER ELIZABETH JOSEPHINE Voting Precinct: CLARKSVILLE
Mailing Address 1: 2621 LOCKWOOD DRIVE Planning Jurisdiction: Davie County
City: WINSTON SALEM Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27103-0000 Voluntary Ag.District: No
Legal Description: 1.182 AC LIBERTY CHURCH RD Fire Response District: WILLIAM R. DAVIE
Assessed Acreage: 1.08 Elementary School Zone: WILLIAM R DAVIE
Deed Date: / Middle School Zone: NORTH DAVIE
Deed Book/Page: Soil Types: MnC2,MnB2
Plat Book: 12 Flood Zone:
Plat Page: 108 Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 15980.00 Total Market Value: 15980.00
Total Assessed Value: 15980.00
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
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
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Davie County Health Department Ole
8 Environmental Health Section
D P.O. Box 848 ( 1
RM,CEIVE 210 Hospital Street
Courier# : 09-40-06 5I A 1 I au i�
b I '•
Dam, Mocksville, NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling onnection
0(Name: N Phone Num er 33� -7 r l ��/ ( e)
Mailing Address: 30 q l 64-10110jood '>r► (Work)
je,", , J[C 0_7103 Email Address:
Detailed Directions To Site: r k f— 6 0 1 rL) b6 7 (k Or° M.
u 1� o'. S� r ve_�xy o n CL)
Property Address: 15gl i � � • Q ko®, y f With-� (. �3
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: �-/�x /7 iltJ ? Type Of Facility: �
Date System Installed(Month/Date/Year): Number Of Bedrooms: 3 Number Of Peopl
Is The Facility Currently Vacant? es No If Yes,For How Long? '
Any Known Problems? Yes ( If If Yes,Explain: V
fto
Please Fill In The Following Information About The NEW Facility: NX
Type Of Facility: Number Of Bedrooms: Number of People
Pool Size: Garage Size: Other:
/fkequested By: Date Requested:
( ignat
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date: — C,
*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.
Payment: Cash Check Money Order # Amount:$ Date:
Paid By: Received By:
Account#: U H Invoice#:
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All data is provided as is whhout surnrdy or guarantee of any kind ether expressed or Implied Including but not limited to Ore Implied
'W `Y us mantles of merchantability or fMess for a particular use.All users of Cycle County's GIS website shall hold harmless the County of C
Davis,North Ca rolina,its agents,consultants contractors or employees from any and all claims or causes of action due to or arising out printed:Aug 06, 2015of the use or inability to use the GIS data provided by this website.
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Davie C.,ownty Health Departniew r Welt
q 18 Elivi •omental Healtli Section
* srP.O. Box 818'CVT01D 210 I'lospilal Sweet
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C Curio ft : 09-10-06
MoclumilIV, NC 27028
PI (3361-7543.67€0 Fax:(3%)•-753-1680
ON-SITE WASTEWATER CERTIFICATION -�-�-------
(Gheck One) Replacement Itcrnoticlin unnection
tY Name: P1 ,Phone Num �r �.3 { i - {y e)
Mailing Address: �� c-f���tch�e� �► � (vi'ark)
... f 'E? _ 7I U Fn�:tl l rdclress: t t'. f;Cr?c� `" ►. �ra' '
Detailed Directions To Site: d- fa L} L T&CA Booe
Property Address:
_/J'r1`SL ! 4 '! c.�
Please Fill In The Following Information About The R'XISTING Facility;
Dame System lnstalW Under:k !rZ t,�{I # 'type Of Facility: -
Date System installed(Month/Date/Year): _Number Of Bedrooms: � Number Of People:
is 17te Facility Currently Vacant? Ycs No if Yes,For flow Long,?
Any l.'nown Problems? 'Yes (No li"Ycs,Explain:
Please Fill In The Following Information About The MW Facility:
Type Of Facility, NurnberorBedrooms: � _Number of People_
Pool Size:_ Garage Size: _ _ Other;p_
Acquested By: _.._.._._. Date Itcqucsted:___ ..
( ignal
For Environmental Health Office Use Only
AA q -Q�
Approved Disapproved
Environmental t lealth Specialist natty. L_ �0
*The signing,of this forth by the L.nvironntenta ealdi i fff ided,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, I
Pnytnent: Cash Check Money Order N^
Paid By .. » . ._.__...� Rcreivecl E3y=
Account# _^ _ . __.._ Invoice et:
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HEALTH DEPARTMENT RELEASEFor Officeuse only
*CDP File Number 193693- 1
Davie County Health Department
d ��`"'F" 210 Hospital Street County ID Number:
P.O. Box 848 Evaluated For: HDR/WWC
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID 0 5 / 1 9 / 2 0 .2 0
UNTIL:
Applicant: Anthon y J. Cameron Property Owner: Anthon y J. Cameron
Address: 126 Aurora Lane Address: 126 Aurora Lane
City: Advance City: Advance
State/Zip: NC 27006 State/Zip: NC 27006
Phone#: (336) 399-82
399-8267 Phone#: (336) 67
Property Location&Site Information
Address 126 Aurora Lane Subdivision: Phase: Lot:
Road#Advance NC 27006
SINGLE FAMILY Township:
*Structure: Directions
#of Bedrooms: 3 #of People: hwy 801 North
*Water Supply: N/A
Type of Business:
Basement: F-1Yes[—]No
Total sq.Footage: No.Of Employees:
*Proposed Improvement:
Build House
Characters
*Release Conditions Remaining
Home must be no closer to well than 25 feet and no closer than 5 feet from any portion of the existing septic 641
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? O Yes ONO
Applicant/Legal Reps. Signature: *Date:
*Issued By: 2140-Nations,Robert *Date of Issue: 0 5 / 1 9 / 2 0 1 5
Authorized State Agent:�o
"Sle Plan/Drawing attached."
®Hand Drawing 0 Import Drawing
HEALTH DEPARTMENT RELEASE 193693 --1
co Davie County Health Department CDP File Number:
210 Hospital Street
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 05 / 19 / .2015
O Inch
Scale: O Block :--_ft.
Drawing Type: Health Department Release O NSA
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HEALTHDEPARTMENT RELEASE
ao- Davie County Health Department
y 210 Hospital Street193693 - 1
CDP File Number:
P.O.Box 848
Mocksville NC 27028 County File Number:
Date: A5./.1.9. �.a.0 1.5.
Drawing Type: Health Department Release
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