279 Shady Knoll Ln (2)Davie Countv. NC Tax Parcel Report Friday. October 7. 201 f
WARNING: THIS IS NUIT A SURVEY
Parcel Information„ y
Parcel Number: J20000003504 Township: Calahaln
NCPIN Number:
5718008646
Municipality:
Account Number:
82531420
Census Tract: 37059-801
Listed Owner 1:
MARTINEZ ORTIZ J ASUNCION
Voting Precinct: SOUTH CALAHALN
Mailing Address 1:
279 SHADY KNOLL LN
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:
10.268 AC SHADY KNOLL RD TR 4 WALKER
Fire Response District: COUNTY LINE
Assessed Acreage:
9.50
Elementary School Zone: COOLEEMEE
Deed Date:
12/2009
Middle School Zone: SOUTH DAVIE
Deed Book / Page:
008150499
Soil Types: ApB,WeC,RnD
Plat Book:
0009
Flood Zone:
Plat Page:
291
Watershed Overlay: DAVIE COUNTY
Building Value: 206310.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 75770.00 Total Market Value: 282080.00
Total Assessed Value: 282080.00
t v� All data is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the
9 1PJ6 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
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1 � C or arising out of the use or Inability to use the GIS data provided by this website.
Davie County Environmental Health P ,
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 j,/0
(336)753-6780/Fax(336)753-1680
WELL PERMIT
Account #: 990005405
Billed To: Asuncion "Chon" Martinez
Reference Name:
Proposed Facility: Residential Well
Tax PINIEH #: 5718 -00 -8646 -Well
Subdivision Into:
Location/Address: Shady Knoll Lane -27028
Property Size: 10.268 Acres
ATC Number: 0045
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there.
has been a material change in any fact/circumstances upon which this permit was issued.
Permit Type: New Nf Repair ❑ Abandonment ❑
Proposed Well Location Diagram
Certificate of Completion Diagra
7 /�t�h��v
Kra(- uYt
� p OOL %j -
Comments:
Comments:
Driller: 1L4 I.1
Certification #. 2-1,31-4
Grout Inspected: //(P// 7_
Well Head Inspected: 1277/)(7/2-
277`)(7/2GPS
G-Coordinates: S°
US
EHS:Date:
t;E'%S( i l � in Date:
W.P. 7-08
APPLICATION FOR PRIVATE WELL PERMIT
Davie County Environmental Health
P.O. Bog 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336) 753-1680
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name to be Billed 11 " r'4ijgtz. Contact Person Ch on Ma r --}i a e7 -
Billing Address Home Phone 751 all SS r%
City/State/ZIP C a7 Business Phone ,33(o- 41,p2 - Q/qSG
Name on Permit if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Comers Flagged
ivv ir;: A survey piat or sitepian must accompany this application. Included: V Site Plan ❑Plat (to scale)
Owner's Name Y Vf ✓ Phone Number33(i--7(p5-aya4
Owner's Address_S3D4 IDId larif ,-r;on Gr City/State/Zip WjnS-bh- SA.I[lrt PJL Q7/22C
Property Address Lot td Shp clq Knoll I Aft r- City MOC,�G
Lot Size /D. ?V8 W re S Tax PIN# 45714Z Oo q(pq e
Subdivision Name(if applicabl�CMCITLq
Section/Lot#
Directions To Site: bQVIG Road rn rl`� t On r�u �il tone
Lal 4 oft lept
DEVELOPMENT INFORMATION
PermitType: NewWell V WellRepair Well Abandonment Uther sped
Facility Type: Residential Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES NO -3/-
Do You Intend To Install A New Septic System On This Site? YES �/ NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine the best location for a well.
- Qfltiyif 0211 NW At hCZ— t 1i,ksT _
Signed
7/30/09
I -I-r3' 0
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS: ''//,,,,
Account # J�YUt-,-
Invoice # Ilaz
NOV-08-2012 06:57 AM CLYDE RUSSELL 8286322617 P.01
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1s. REMARIf.9:
I DO H12REB1f CERM THAT THIS WELL WAS CONSTRUCTED IN
AICCOROANCE WITH 15A NCAC 20. WELL CONSTRUCTION
STANOPM& AND THATACWY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL. OWNEK
OF tam vrow WELL COMRAG TOR BALE
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