198 Old Homeplace Dr Davie.County,NC Tax Parcel Report Monday,November 28, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Number: _G8140A0084 Township: Shady Grove
NCPIN Number:; 5779688017 Municipality:
Account Number: :-<8305485 Census Tract: 37059-804
Listed Owner 1:- --- OGNOSKY MICHAEL D! Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 198 OLD HOMEPLACE DRIVE 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: .72 ac Summer Hill Farm Lot 84: Fire Response District: ADVANCE
Assessed Acreage: 0.72 Elementary School Zone: SHADY GROVE
Deed Date: . 9/2015 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 010000044 Soil Types: PcB2
Plat Book: 10 Flood Zone:
Plat Page: 223 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
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.
Davie County Health Department
91836 Elivironmental Health Section
,r R IVED P.O. Box 848 {
Ct'' aa
210 Hospital Street
Courier# : 09-40-06 -J11 -
Mocksville,NC 27028
Phone:(336)-753-6780 _ Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
- (Check One) Replacement Remodeling Reconnection
Name: ! 'r�""^�' �jEc Phone Number �3 0/--5-6 q^-7f' / (Home)
Mailing Address: t�tl"p r 1�W �"'�( �F �r 3X- )'Is do4� (Work)
AX-tee, lv( X7 0,1(^
Detailed Directions To Site: 8�� MO"�` /~' 7'�/n on .,�,� 11-1/-A Al-k
S�Mrs ��� � �^I , r``�� �r� �GT�' ti �,tl� Se �r� Lu.�4 'N'n^ `Pn✓1 �
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Property Address: �9 Old /`e/ �/j- V^^�. /k prjGk7G
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility: 14 -
Date System Installed(Month/Date/Year):- OW/6 -Number Of Bedrooms:_�_Number Of People
_ p - _
Is The Facility Currently Vacant? Yes QL
oj If Yes,For How Long?
Any Known Problems? Yes oNo If Yes,Explain:
Please Fill In The Following Information About The NEIV Facility:
Type Of Facility:_Sk ra0"a &LO(//jyl4 /Q X/0 Number Of Bedrooms: Number of People
Pool Size: Garage Size: Other:.
Requested By: Date Requested:
(Signature)
For Environmental Health Office Use Only
pedDisapproved
C
Environmental Health Specialist
*The signing of this fonn 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#: Invoice#: