201 South Angell Road Lot 1• I.
Davie County, NC Tax Parcel Report Tuesday, November 8, 2016
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ARM!?All data is provided as Is whhoutwarramy, or guarantee of any kind eltberespressed or Implied Including but not limited to the
Davie County, Implledwarrandesofinetchantabllgy"llumm,form pagcularuse. All usenor[NWeCountysGISwebalteshall hold harmlesethe
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County of Ga de, North Carolina, gs agents, consultants, contractors or employees tram any and as Gelms or causes "action due.
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WARNING: THIS IS NOT A SURVEY
Parcel
Information..-._
.
Parcel Number.,
G56000000902
Township:
Mocksville
NCPIN Number:
5840103388
Municipality:
Account Number:
82532036 - -
Census Tract:
37059-806
Listed Owner 1:
HOLLAR RICIE R
Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1:
201 S ANGELL ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 1 BROWNSTONE VALLEY
Fire Response District:
MOCKSVILLE
Assessed Acreage:
0.98.
Elementary School Zone:
MOCKSVILLE
Deed Date:
3/2016
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
010130469
Soil Types:
PaD,RnD,CeB2
Plat Book:
0007
Flood Zone:
Plat Page:
031
Watershed Overlay:
DAVIE COUNTY
Building Value:
57410.00
Outbuilding & Extra
0.00
Freatures Value:
Land Value:
23460.00
Total Market Value:
80870.00
Total Assessed Value:
80870.00
ARM!?All data is provided as Is whhoutwarramy, or guarantee of any kind eltberespressed or Implied Including but not limited to the
Davie County, Implledwarrandesofinetchantabllgy"llumm,form pagcularuse. All usenor[NWeCountysGISwebalteshall hold harmlesethe
j�j
County of Ga de, North Carolina, gs agents, consultants, contractors or employees tram any and as Gelms or causes "action due.
r•Ohf,,t NC drinking out ofthe use or lnabllltyto usethe GIS data provided by this wobage
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001006 Tax PIN/EH #: 5840-10-3388.01
Billed To: 4tobatt32rEdward Shultz Subdivision Info: Brownstone Lot#RQJ r
Reference Name: award Shultz Location/Address: South Angell Road -27028
rosea t-acinty: Kesioence rropeiry maize. i.uva MuMb
ATC Number. 2343
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATXI CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature:
Date: —acs?
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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 fimction satisfactorily for any
given period of time.
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Sep is System Installed By: /
Environmental Health Specialist's Signature: a714
J Date:
DCHD 05/99 (Revised)
Y DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mockwille, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001006 Tax PIN/EH #: 5840-10-3388.01
Billed To: 40WApWh Edward Shultz Subdivision Info: Brownstone Lot##fa
Reference Name: Edward Shultz Location/Address: South Angell Road -27028
Proposed Facility: Residence
Property Size: 1.009 Acres
d)&QVff**N07 E""TriIs�nproveemn nt/Operation Permit DOES NOT authorize the construction 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM c /
CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type /' / i /TDAI6- #People r_ #Bedrooms t #Baths —0�_
Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine:X Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size (D Type Water Supplyje Design Wastewater Flow (GPD) ZYL-0— Site: NewX1 Repair ❑
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width yo__ Rock Depth Linear Ft
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health
DCHD 05/99 (Revised)
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Specialist's Signature: Date:
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APPLIC4TION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department
Envimnmenta/Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)761-8760
Name to be Billed
Mailing Address
city/state/zIP /11 D P 'K 5 1/! 1
Naas on Permit/ATC if Different than
Mailing Address
3. Application For: ❑ Site Evaluation
e. system to service: ❑ House ®'Mobile Home
City/state/Zip
limprovement Permit/ATC ❑ Both
❑ Business ❑ Industry ❑ Other
S. if Residence: a People 3 t Bedrooms 3
�� t Bathrooms ?-�
Voishwasher (.I Garbage Disposal 04-ehing Machine fl Basement/Plumbin
4 I.1 Basement/No Plumbing
6. If Business/Industry/Other: specify type
p People / Sinks
Y Commodes i Showers i Urinals
# Nater Coolers
IF FOODSERVICE: # Seats e Estimated Water Usage . ��(gallons per day)
7. Type of water supply: ❑ County/City D"Well ❑ Community
e: r Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes
UN011
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION.
i
Property Dimensio= / /k ,
Tax Office PIN: #S l}IAfl ^ /D ^ 3 3 S S
Property Address: Road Name SDRd
City/Zip m n�z&sy-L P /YC
If in a Subdivision provide information, as follows:
Name:
Section Block: Lot:
WRITE DIRECTIONS (from Mocksvilie) to PROPERTY:
15� &01;, , 1-o /hxia Chvh�ll �l
60giYDI �1�arA('�nnr� 1i�n �Jtoiyj
Date Property Flagged: 5--j-0e
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
to conduct all testing procedures as necessary to determine the site suitability.
DATE1=� "t) SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
\ Account No.&S-27-7
Invoice No. IBJ-/
/ACL
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(J APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department u LK
<d/ Environmenta/Health Secrion 2
S / /"'/v j ,t�l��'"""0�'� P.O. Box 848/210 Hospital Street FB3
I l 11/ `JfJ I Mocksville, NC 27028
//( �% /Il� �U (336) 751-8760 ENVIRONMENTAL HEALTH
=...ELIE COON
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED ry
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for (instructions/.
ame `I
1. Nto be Billed (J cr- Contact Person 1)OIQef�j�]e(y1�
Nailing Address '�/J7 Some Phone �.3�3(( \) ,`]y(7�c-(.0��3y
City/State/ZIP 1 IQ(✓�} J I `I X11. 27Q � 3 Business Phone 33.0)
2. Name on Permit/ATC if Different than Above '
Mailing Address
3. Application For: ❑ Site Evaluation
4. System to Service: fl House FMiobile Home
5. If Residence
II Dishwasher
Cit/y//SYate/Zip
LY YImprovement Permit/ATC
11 Business
# People _ Y Bedrooms
II Garbage Disposal I' waahing Machine
6. If Business/Industry/Other: Specify type
❑ Industry I1 Other
3 Y Bathrooms
II Basement/Plumbing
# People
ed th
II Basement/No Plumbing
# Sinks
Y Commodes # Shorera # Urinals
Y water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: II County/City W/well ❑ Community
not c-,- Q�o�a(�Y Vet -
8. Do you anticipate additions or expansions of the facility this system is intended to serve? IJ Yes V<O
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN M ST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: l J Q RITE DIRECTIONS (from Mocksville) to PROPERTY:
LL— 3'10-- o (
Tax Office PIN: # ' n` i HW ;' 76 //Pa/7)C-k , AJ
Property Address: Road Name f S, I'1 1 /' Y)�
/C /'e--fLoh n L' /,Oat hLQYt
city/zip n"'( kSu)/�e i1C 27y�S h &Jq-) 12W/ p.�
If in a Subdivision provide information, as follows:
Name: /� 14-o':7 S��-.,7e_
Section: Block: Lot: Date Property Flagged:
Jt�' LotZ
This is to certify that the information provi ed is coWeet 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 1, 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
to conduct all testing procedures as necessary to determine the site suitability. / / )
DATE � '4? � kw' SIGNATURE JJI (� C,
/
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the followin : Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Client Notification Date:
EHS:
Revised DCHD (07/99)
Account No. &)ID6
Invoice No. -G J`
Is
5
4' /000-/