2154 Liberty Church Rd . �Davie County, NC Tax Parcel Report a'��p� Monday, October 3, 2016
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WAI2NING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: 6200000015 Township: Clarksville
NCPIN Number: 5803950892 Municipality:
Account Number: 78300000 Census Tract: 37059-801
Listed Owner 1: WHITAKER WILLIAM THOMAS Voting Precinct: CLARKSVILLE
Mailing Address 1: 4383 NC HIGHWAY 801 NORTH Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,R-20
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 19.00 AC LIBERTY CHURCH Fire Response District: LONE HICKORY
Assessed Acreage: 18.67 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 11/2008 Middle School Zone: NORTH DAVIE
Deed Book/Page: 007760305 Soil Types: MnC2,Mn62,ChA,MdC,RwA,MdE
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 18680.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 72730.00 Total Market Value: 91410.00
Total Assessed Value: 35110.00
�v� All data is provided as Is without warranty or guarantee of any kind either expressed or implied including but not Iimited to the
9�""F Davie County� Implied warranties ot merchantability or fitnesa tor a paRicular use.All users of Davle County'e GIS wobsfte shail hold harmless the
Nn County ot Davle,North Carolina,its agents,eonsultants,eontractors or employees trom any and all claims or causes of action due to
np���x.�'� �� or arlsing out of the use or Ina6ility to use the GIS data provlded by this websito.
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Perm��tee's ,��`"`��� ' DAVIE COUNTY HEALTH DEPARTMENT
. Name �f'��f�f,,;r: 4'�'� .j� � � Environmental Health Section PROPERTY INFORMATIO
' , � P.O. Box 848 �Q�/v�
Directiors to property:r�^���?� .�%;` 1��_� ,-',- ��]�qocksville,NC 27028 Subdivision Name:
_ � �'� � . Phone#:336-751-8760
i,t.a�,;:,�' �f�l.r�,r' ar,�f�✓�:'!r ' _ '�� ;'�.- Section: Lot:
�� ' �� , � AUTHORI7,ATION FOK
,, r��„! ',,� r, �+'`f,�;�l WASTEWATER Tax Office PIN:#
ti / ':r`"f� "4�A'r� � - r ri SySTF.M CONSTRUCTION - -
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ALJTHORIZATION NO: ����� A Road Name• ��.�' �"Zip:
**NOT'E**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 Perrnits.
(ln compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
�
>� � '. �'". C.. � ''=� ***NOTICE***TH1S AUTHORI7ATION FOR WASTEWATER CONSTRUCTION
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,:';`'� �,::��''� p%�`�,°�'��� > �',f�,�'� !?,,.5� IS VALID FOR A PERIOD OF FIVE YEARS.
� ENVIRONME TAL HEALTH SPEC(ALIST DATE ISS ED
RESIDENTIAL SPECIFICATION:BUILDING TYPE�, #BEllROOMS�#BATHS�% #OCCUPANTS,�GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIET #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE / �' TYPE WATER SUPPLY //l%/ DESIGN WASTEWATER FLOW(GPD)—� NEW SITE REPAIR SITE�
/ // ,
SYSTEM SPECIFICATIONS: TANK SIZE�GAL. PUMP TANK GAL. TRENCH WIDTH�rROCK DEPTH,,,�.�.� LINEAR FT�r+�'L�
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: '
IMPROVEMENT PERMIT LAYOUT
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**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[NSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTE NSTA ED BY: 1���`'�� � nL"�
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AUTHORIZATION NO. .�� OPERATION PERMIT BY: � �E�GL�fi(i'' � DATE: LS � '
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**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. �
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' APPUCATION FOR SITE EVALUATION/Ih1PROVChiCNT PCRM17&ATC � �7�c� S
• : .Davie County Heaitt� Department
Environmenta/hlea/th Section
P.O. Box 848/210 Hospital Street
� Mocksville, NC 27028
(336)751—£3760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCES5�D UNLESS ALL TIi� R�QUIR�D
INFORMATION IS PROVIDED. Refer to tho INFOR2dAT20N IIULLETIN for inrstructiona.
l. Nama to be Dillod ��LL/,��_�/iJ�/T"",�f�� Contact Per�on /LC/ ;, /D�9
Mailing Addreaa �' �3 �Ie rT LC�� ��j� �� Home Phono %9�'33�'Q �/f/�fC£
City/Stata/ZIP �'/lSclCS(//Lf�-` r�C v2�4o�A �s Phona 33� '�`/Lf�—�.�6
2. Name on Pormit/ATC if Diffarent than Above .S/Y3'Y�� --
Mailing Addreas City/Stato/2ip /��
� � 5�7�77C
3. ApplicaL•ion For. '� Si Svaluation ❑ Improvement Permit/ATC Doth
S�yS)T��L�
4. Syutum to servico: House ❑ Mobile HomQ ❑ Businesa ❑ Industry ❑ Othar �ti'�Y
5. Type ayatem requestods Conventional ❑ convenCional modified ❑ innovative •
6. If R idence: �k People -� # Bedrooma �, It Bathrooma �
C.ID18hwasher ❑Garbage Disposal (7dWanhing Machine ❑Basement/Plwnbing OIIasemont/tto Plumbing
7. If Duainess/Induatry /Othur: veriEy type �✓� # Paoplo �- 1t Sinka —
# Coaunodea� �F Showors # Urinala U Wator Coolera "�---
IF FOODSERVICE: �� Seata - Eatima�ed Water Uuage (gailons per day) —
s. Typo of water aupply: 0 County/City Lti�Well ❑ Community
9. no you anticipato additions or cxpansions of tlic facility tl�is systcn�is i►�tciidcd to scrvc? 0 Ycs I�.NVo •, _ _
If��cs,tivl�at typc? �''✓D�'✓� —"'
***IAIPOIZTANT***CLILNTS dIUST C0�11PLETE TIIG REQUlRL•D PROP�R1'Y 1NP'ORA�IATION RGQU�S1'CD
BELOW. Githcr a PLAT or SITG PLAN AfUST BESIIBAf17TGD by tl�c clicnt witli T}IIS APYI,iCr�TION.
P1'opct'ty Ditilcltsions: r� �r'�'� 1VRiTG DIRCCTIONS(frmn lYlocicsvilic)to PROPGIZ'I'Y:
Taa o rr,��rirr: f� S�'"D.�y�S"D�"y� .yuy G�G/ .✓okr�/ T� ��,���..�--y �.�- �v-T,�l�c�"
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Property Address: Road Namc �/��� Ch�t/�L,�f ,�L� «f" T - �s-� �unrl�r�.g.-,a.s �i�'�-��
c;tyiz,n ��J���cc� �'/� (.�!'�it S/�� Lyi« �o�✓ L�7�=T�
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ICin a Subdivision providc information,ls follotivs: S�i /�r..�T.F �/C1�'/���C / �'�«'� �'�
Namc: /✓/r -� �iG,y-7r- !�'i��' t�c..�tc �-/ 6���-�%��r"
Scctioii: Blocic: Lot: Datc liomc corncrs ilabecd: s2`!�//Zf�i D'���
Tliis is ta ccrtify that thc inCormation providcd is corrcct to tl�c best oTnry knotivlcclgc. I widcrstand tliat auy permit(s)
issued licreafter are subject to suspensiou or revocation,if tlie site plans or inlended use ct�auge,or if tl�e inform:1t1011
subruitted in tl�is application is falsiGed or clianged. I,also,tuulersltrnr!!liR1I rrnr respo�rsiGlc jvr rrll cJrarges i�rcrrrrerl jruur
tlris application. I,liereby,give consent to the Authorized Represcutalive of tl�e Davie Cowily I-Icalth Dcpartment
lo critcr upon:�bovc dcsc►•ibcd propertJ'IOCIIfC(I lIl DAYic Count}':lIl(� ONIIC(I li)' /.r/ii�i�-+� ,./; /�.�/fir�3?�'��
to conduct alt tcsting proccdures as licccssary to dctcrminc.tlic sitc suitabilit3�.
DAT� ' � — ��—Q S� SIGNATUR����i l`�'�����""
. �
TIiIS AIt�A MAY B�US�D TOR DRAWING YOUR SIT�PLAN(Iiuludc all of tlic follo�ti�ing: �xistiiig at�d pr�I�osed
property liues and dimensions, structures, setbacics, and septic locations).
, Sitc Rcvisit Cl�arbc
, • Datc(s):
Clicnt NotiGcation Datc:
�IIS:
Sign givcn N v Account No. � �3 ��
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