133 Shady LnDavie County, NC
Tax Parcel Report 14 J a(L Thursday. October 6. 2016
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
1071
NC or arising out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
D700000172
Township:
Farmington
NCPIN Number:
5862904361
Municipality:
Account Number:
58252000
Census Tract:
37059-802
Listed Owner 1:
POTTS WILBURN AVALON
Voting Precinct:
SMITH GROVE
Mailing Address 1:
3201 CENTRE PARK BLVD
Planning Jurisdiction:
BERMUDA RUN
City: WINSTON SALEM
Zoning Class:
BERMUDA RUN RM
State:
NC
Zoning Overlay:
BERMUDA RUN MH -O
Zip Code:
27107-0000
Voluntary Ag. District:
No
Legal Description:
LOT 2+ SHADY LANE
Fire Response District:
SMITH GROVE
Assessed Acreage:
1.30
Elementary School Zone:
SHADY GROVE
Deed Date:
9/1984
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
001240223
Soil Types:
GnB2
Plat Book:
0003
Flood Zone:
Plat Page:
048
Watershed Overlay:
BERMUDA RUN
Building Value:
101940.00
Outbuilding & Extra
Freatures Value:
0.00
Land Value:
27370.00
Total Market Value:
129310.00
Total Assessed Value:
129310.00
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
1071
NC or arising out of the use or Inability to use the GIS data provided by this website.
AUTHORIZATION NO. r' DAVIE COUNTY HEALTH DEPARTMENT
1652
Environmental Health Section PROPERTY INFORMATION
Permittce's P.O. Box 848
Name: `�n�-ur'� 0_T1
� S Mocksville, NC 27028 Subdivision Name:
} �tti1K Phone # 336-751-8760
Directions to property: Section: .Lot:
AUTHORIZATION FOR
S4 Lr'3 itl f S7 U� WASTEWATER Tax Office PIN:# -
SYSTEM CONSTRUCTION '
i"3 �I � Y L Zip: C.
Road Name: — ��
**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 I 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.
ENVIRO 1 NTAL HEAT �H SPECIALIST DATE ISSUED
- 1 53 2 A DAVIE COUNTY HEALTH.DEPARTI41ENT
-' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION '
PPrrntte� s �'
Name�`���� �"� i.71 - Subdivision Name:
Directions to property: f t ~''� '', Section: Lot:
IMPROVEMENT
�, -, ,; rJ c�,•) �L �� PERMIT Tax Office PIN:# .
r•
Road Name:
**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 1.1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
. ^"^ •, ***NU1'IUE***1 IM FERMI '1' 1J JUBJEUT "1U REVUUATIUN 1N' SITE
t''i? PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRO MENTAL HEALTH SPECIALIST DA I SUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE [10 4t # BEDROOMS f # BATHS s - # OCCUPANTS --7- GARBAGE DISPOSAL: Yes o <No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
►� J S /'
LOT SIZE (,,' �� � TYPE WATER SUPPLY CL -L DESIGN WASTEWATER FLOW (GPD) �� NEW SITE REPAIR SITE ✓
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH S(;'ROCK DEPTH `f LINEAR FT. •- -3
' OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
-_-_ -. t
IMPROVEMENT PERMIT LAYOUT *APPROLIED EFFLUMIT FILTER* cRISr-R(IF 5" BEI -00 FRIISHED GRADai:
flt���. Gh�v Nj
Y
1 `
4F,�Q
C `gyp a
"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 ST��LATION. TELEPHONE # IS (M4163A-SMRX
7O \ (3-76)751-0750
OPERATION PERMIT
N%:4,) 14a \<� T
WAT11-- WAf ►lt C& IX F0
10 cod-ly— VOL wav-_s
115
SYSTEM INTALLED B
1
1=2o.J'
tA
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AUTHORIZATION NO. W OPERATION PERMIT B6
ATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE ST DESCRIBED ABOV BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATME ND 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)
a
NAM
2.'m
• DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
•� APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER /
ADDRESS <.�� ����� 1-� SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE I Sl;� 'Tp Su&oy L-"
DATE SYSTEM INSTALLED )9107 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY I4t"051<� NUMBER BEDROOMS -3 NUMBER PEOPLE SERVED �2-
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING�-�'J6
1t io 40 JSP
DATE REQUESTEINFORMATION TAKEN BY____
This is to certify that the information provided is correct to the best of my knowledge,
[SIGNATURE OF OWNER OR AUTHORIZED AGENT_
Rev. 1/93
P//1/
I am r p Bible for all charges incurred from this application.