109 Holly Hill Ct Lot 17 Davie County,NC Tax Parcel Report Tuesday,November 1, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information � -
Parcel Number: G9090B0017 Township: Shady Grove
NCPIN Number. 5789779154 Municipality:
Account Number: 8304652 Census Tract: 37059-804
Listed Owner.1:. _ SHENETTE JOHN J . Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 109 HOLLY HILL COURT Planning Jurisdiction: Davie County
City: Advance Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006 Voluntary Ag.District: No
Legal Description: LOT 17 MARCH WOODS PHASE ONE Fire Response District: ADVANCE
Assessed Acreage: 0.76 Elementary School Zone: SHADY GROVE
Deed Date: 1/2015 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 009770188 Soil Types: WeB
Plat Book: 0007 Flood Zone:
Plat Page: 054 Watershed Overlay: DAVIE COUNTY
Building Value: 220430.00 Outbuilding&Extra 2110.00
Freatures Value:
Land Value: 40000.00 Total Market Value: 262540.00
Total Assessed Value: 262540.00
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 ail 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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r`r ,NO: � D. 147AVIE COUNTY HEALTH 1DEPARMNTi���'"'`.Y`/^�/
r Environmental Health Section PROPERTY INFORMATION
Permitte s . ��J P.O:Box 848
Name: ' �t�P` 1' Mocksville,NC 27028 Subdivision Name: "./ddly�
Phone#:704-634-8760
o ^,�.` <( �
• Directions to property:' A J �i Section: Lot:T
AUTHORIZATION FOR /
>WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION �+�
19 / -"�� 11r .l./ +.Road NameVii? > / �`^./Zip: Z 7v u G
**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,l l of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
--� ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
DATE ISSUED
ENVIRONMENTAL HEALTH S�P IALIST
7 Farr 1C ij
DAVIE COUNTY HEALTH DEPART NY
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
MPermitte 'g-, ' ) .
Namfief = 1C_4 111 ' Subdivision Name ,�~ =j -ter. r� .✓{S'`
�Direirtions'to property: Section: Lot:
IMPROVEMENTJ p / �✓
+ PERMIT Tax Office PIN:# �`
10-Idr �Il�� Road Name, -E /'r; ''Zi
r p:
**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)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
Cif 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 #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SrrE /REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE !PLD GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.Je
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT �►
r � `
F
"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
S S STALLED BY:
/
AUTHORIZATION NO. OPERATION PERMIT BY: DATE.
"THE ISSUANCE OF THIS OPERATION PERMrr 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 F.VALUATION/IMPROVEMENT PERF A W( M
` Davie County Health Department D R U
Environmental Health Section
P.O. Box 848 JUN - 8 1%8
Mocksville NC 27028
( 3 6)751-8760 I ENVIRONMENTAL HEALTH
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCES DAVIE COUNTY
ALL THE REQUIRED INFORMATION 1S PROVIDED.��
1. Name to be Billed :�/<',� QNDf=/z8 0.()�dU.Si .TNC . Contact Person l!G
Mailing Address WIAI G- 47(142–Al Z AI. Home Phone Pv ' 7S 7 9 ;
City/State/Zip �MQC&S y"44 Z-- C .270 a S' Business Phone 33G qq2-7d7 q
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
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
l Dishwasher X Garbage Disposal 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: County/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?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLATM THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: R�47- d0e.,' / SAP CLUSc� 1 WRITE DIRECTIONS(from
_ 1 Mocksville)TO PROPERTY:
Tax Office PIN: # 7 g - 76 - ,� •5 % i
1 S8 Tv a
gi - 7Z%e-A)
F-3
Property Address: Road Name � oP (/+iP!F�K PO. 1
1 A�1- T'O 1-70A
City/Zip Ao>lAAxg. (" d-700 '
' 7&U' J pit/
I
If in Subdivision provide information,as follows: 1
1 K
Name: j0Ai2C14 &V0QQS 1
1 n�ic.E.g
Section: Lot #: �•7 1
1 I4UCtWS DAY �r.
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 Representative of the
/Davie County Health Department to enter upon above described property located in Davie County
and owned by L/Of�/ll H. �OU T to conduct all testing procedures
as necessary to determine the site suitability.
DATE 6 — 6 ^ V9 SIGNATURE
Revised DCHD(06-96)
JOU MAY USE THE BACK OF THIS FORM FOR PRA WI NCG YOUR SITE PLAN. fiPP -P o��
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//y , /, �� / �/ NOTES
1. ALL LOTS ARE SUBJECT TO DAME COUNTY
HEALTH DEPARTMENT STANDARDS.
2. ROADS ARE TO BE BUILT TO NCDOT STANDARD
BEING A PUBLIC ROAD WITH A 60' RIGHT-OF-WAY