170 Citadel Road Lot 9Davie Countv. NC �~ �' Tax Parcel Report Tuesday. November 15. 2016
WARNMG: THIN 15 NU7' A SURVEY
Parcel Information
Parcel Number:
F3010A0009
Township:
Clarksville
NCPIN Number:
5811737068
Municipality:
Account Number:
82521555
Census Tract:
37059-801
Listed Owner 1:
HENNE KENNETH
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
168 CITADEL RD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-4979
Voluntary Ag. District:
No
Legal Description:
LOT 9 CHARLESTOWNE GRANT
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
1.72
Elementary School Zone: WILLIAM R DAVIE
Deed Date:
9/2003
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
005140222
Soil Types:
MnC2,MnB2,MdD
Plat Book:
0007
Flood Zone:
Plat Page:
102
Watershed Overlay:
DAVIE COUNTY
Building Value:
0.00
Outbuilding & Extra
Freatures Value:
0.00
Land Value:
28000.00
Total Market Value:
28000.00
Total Assessed Value:
28000.00
101
Ail 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 webette shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ail claims or causes of aW on due to
NC or arising out of the use or inability to use the GIS data provided by this website.
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmenta/Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***n-1P0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed 7' ,d
(:�—O'Cz c ez—
Contact Person l� -4--J
Mailing Address 93 2
104-mc:1 rg 6E e
Rome Phone `�j�/ Z
t
City/State/ZIP Moe-V-!5:d/L.G
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L� A/- C-- Z /-0 Z �
Business Phone �/ Z
-S*9 0
2. Name on Permit/ATC if Different than Above
Mailing Address
City/state/Zip
3. Application For: X Site Evaluation 0 Improvement Permit/ATC ll Both
4. system to Service: A House U Mobile Home 0 Business U Industry I] Other
5. If Residence: # People # Bedrooms # Bathrooms
U Dishwasher 1.1 Garbage Disposal 11 Washing Machine ❑ Basement/Plumbing L) Basement/No Plumbing
6. If Business/Industry/Other: Specify type
# Commodes # Showers
# Urinals
# People # Sinks
# water Coolers
IF FOODSERVICE: # Seats Estimated water Usage (gallons per day)
7. Type of water supply: County/City 0 well U Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 'I,No
If yes, what type?
***IMPORTANT*** CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESURAUTTED by the client with THIS APPLICATION.
Property Dimensions: Z, O 4f�
�0 _ � � - n � � a�O ,SITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: # i , �/
,•) t 0 / d 4o L/�E,i'rti �w�N
Property Address: Road Name WRGAIFk 1> V
Leri o.J Z"EgE r, Go f
City/Zip[loe-4s✓/t:4..E 2- -r
T ,e,J LEFT o� G✓1gG.Jee �C D _
If in a Subdivision provide information, as follows:
Name: f�" -, � n� —, C+440 LUST0'4&Zo►#.1T
Section: Block: Lot: Orf ri 1XuJ V 3O
MAP
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or it the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. 1, hereby, give consent to the Authorized Representative of the D vie Count,y Health Department
to enter upon above described property located in Davie County and owned by �D • �KaeE� . �� .
to conduct all testing procedures as necessary to determine the site suitability.
DATE �- 1 ' %d SIGNATURE L _