125 Boxwood Circle Lot 160Davie County, NC Tax Parcel Report Thursday, October 27, 2016
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Zip Code:
WARNING: THIS IS NOT A SURVEY
Voluntary Ag. District:
No
Parcel Information
LOT 160 BERMUDA RUN GOLF&COUNTRY
Fire Response District:
Parcel Number:
D8030A0005
Township:
Farmington
NCPIN Number:
5882050523
Municipality:
BERMUDA RUN
Account Number:
82518703
Census Tract:
37059-803
Listed Owner 1:
CHAFFIN KENDALL S
Voting Precinct:
HILLSDALE
Mailing Address 1:
125 BOXWOOD CIRCLE
Planning Jurisdiction:
BERMUDA RUN
City: BERMUDA
RUN
Zoning Class:
BERMUDA RUN CR
State:
NC
Zoning Overlay:
Total Market Value:
Zip Code:
27006-9587
Voluntary Ag. District:
No
Legal Description:
LOT 160 BERMUDA RUN GOLF&COUNTRY
Fire Response District:
CLEMMONS
Assessed Acreage:
0.79
Elementary School Zone:
SHADY GROVE
Deed Date:
5/2002
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
004210439
Soil Types:
MrC2,MrB2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
BERMUDA RUN
Building Value:
281540.00
Outbuilding & Extra
Freatures Value:
42970.00
Land Value:
75000.00
Total Market Value:
399510.00
Total Assessed Value:
399510.00
91 All data Is provided as is without warranty or guarantee of any Idnd 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
NCor arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
P. O. Boa 848/210 Hospital Street s, / S► �° 3
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT f�s
Account #: 990002724 Tax PIN/EH #: 5882-05-0523.KC
Billed To: Kendall Chaffin Subdivision Info: Berm Run Lot # 160
Reference Name: Location/Address: Boxwood Circle -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3449
**NOTE** This Improvement/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 CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING' SYSTEM.
Residential Specification: Building Type 014 #People _ #Bedrooms 12 #Baths .
Dishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
i
Lot Size Type Water Supply —1�— Design Wastewater Flow (GPD) Site: New Repair ❑
System Specifications: Tank SizelAW GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Widthj*:C'Rock Depth /jN Linear Ft._�VAl
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 Specialist's Signature: / Date:
P �►
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002724 Tax PIN/EH #: 5882-05-0523.KC
Billed To: Kendall Chaffin Subdivision Info: Berm Run Lot # 160
Reference Name: Location/Address: Boxwood Circle -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3449
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: fill, Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the%s1t a described on Improvement/Operation Permit
has been installed in compliance with Artic of G.S. Chap er 130,1, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY taly® gu 144he system will function satisfactorily for any
given period of time. ;
f -
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:/
1.
2.
COO? 0 6 Udd
%TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
EnVftfi lenta/Hea/th Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
[WRONMENTAL HEALTH (336)751-8760
DAME COI.NTY
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
Name to be BilledContact PersonY
Mailing Address L -j ®��% L L >I'� l l 1 C�Ir�R ` �T' Home Phone /-�O �G�S 70 y-Z5"o6 -yti3/
City/State/ZIP Q\-e./VC 0IBusiness Phone
Name on Permit/ATC if Different than Above
Mailing Address
3. Application For:
4. System to Service:
5. If Residence:
Dishwasher
Site Evaluation
House; Mobile Home,
# People
City/State/Zip
mprovementPermit C
Business Industry
# Bedrooms
Garbage Disposal Washing Machine Basement/Plumbing
6. If Business/Industry/Other: Specify type
# Commodes # Showers
# Urinals
Both
Other
# Bathrooms .3
Basement/No Plumbing
# People # Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: County;;; y Well: Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? Yes
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #
Property Address: Road Name BD )� �P(xo8 Gly
City/Zip
If in a Subdivision provide information, as follows:
Name: -��� /�Y1. t'C- /6101
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
/ -15� to 7" a &Jr. c a r • SS
5,e ALM b�--,.
Date home corners flagged:
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'pocedu es as necessary to determine the site suitability.
DATE v 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).
Sign given
Revised DCHD (07/99)
Date(s):
Account No. 2524:% ;-- 4
Invoice No.
V
7
(2.05A)
4637
5903
rn
II
m
AM
137
22 2841
N 224 97 w
N
co C�y3S
(1.03A) 2 `�
8 �� ;' cv
8701 7145 1720
2
17s �J (ss)
120
D8030A0005
7516 co 130
N 30
1531
N
8446 588205052 2446
X90 .3474
116........ �►�
5�
' •_ - '. APHON ar ont SMR &ATCoa SITE
Health Dpartme
• ` r �� EnWmnmentel Hes/th Secdon
P.O. Box 848/210 Hospital Street
s
Mocksville, NC 27026 SEP 2 3
1999
(336) 781-6760 -
ENVIR0. ENTAL HEALTH
***nVOR2ANT*** THIS APPLICATION CANNOT BR PROCKSMW UNLESS ALL THE
INPORN&TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1.
Sams to be Billed
K U a r=S K CTSf54
Contact Person
Nailing Address
05-/ GJEsrttr7 c,F Q.1 .
some sbcne 99 9- 33 (y y
city/state/tsp
AVA,-,cE • ,J <— a-7 6U (P
easiness Phone W242-77
2.
Baas on Perait/ATC
if Different than Above
Nailing Address
City/stag/aiP
3.
Application For:
9'Site evaluation
❑ Improvement Permit/ATC ❑ Both
4.
eysten to servioe:
IT'House ❑ Mobile Home
❑ Business ❑ Industry ❑ Other
s.
If Residence:
# People /Y
t Bedrooms `7 3 Bathrooms 3. '5-
elDishwasher M farbage Disposal L4'Iiashing Whohine 0 Bassaant/Pluabing C sasementMo Plumbing
6. If sassiness/Industry/OtherI specify type
# Commodes
Ir MMSERVICZ:
# showers
# Urinals
# People # sinks
# Mater Coolers
# Seats estimated Nater Usage (gallons Per day)
7. Type of water supply: ecounty/City
❑ Well
9. Do you anticipate additions or expansions of the facility this system Is intended to serve?
If yes, what type?
❑ Community
❑ Yes "o,
***IMPORTANT*** CLIENTS M11ST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESIIBMITTED by the client with THIS APPLICATION.
Property Dimensions: Il(n X O�3X 901 S—Fx a87
Tax Office PIN: #
Property Address: Road Name I aS13cxwcol Ciacs—
City/Zip(�E9,14,JbA V1W• LlL -)-`7o>4-
If in a Subdivision provide information, as follows:
WRITE DIRECTIONS (from MockrAe) to PROPERTY:
pwy. /S -it T) 24cc
C(LoSS SPEEb`t�ump dU-n4r-L 1- p -r oi3 _
(L(UyL3G..r�.'%!+✓.- %�rcEfT o.J 3rnwc--b
Name: Reo-M u 6 A R'J-.1
Section: Block: Lot: Date Property Flagged:T�/99
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 we change, or if the Information
submitted in this application Is falsified or changed. 1, also, understand that I ant responsible for all charges Incurred front
this appllcadon. 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 to/sting procedures as necessary to determine the site suitability.
DATE 9/23 LO- SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property Una and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
I Client Notification Date:
I ERS:
Revised DCHD (07/99)
Account No.
iL
Invoice No. Q 7y
` APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Wachovia Bank & Trust Co., N.A. Home Phone J
1. Permit Requested By Agent, MeadeH. Willis, Jr. Business Phone 770-5463
2. Address P. 0. Box 3099, Winston—Salem, NC 27150
3. Property Owner if Different than Above Meade H. Willis, Jr. and wife, Anne H. Willis
Address c/o Wachovia Bank & Trust Co., N.A., P. O. Box 3099, Winston—Salem,
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division -81< Sec. Lot No. l d
5. System used to serve what type facility: House—IL Mobile Home Business
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served'_
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes
lavatory _
dishwasher
urinals
showers
sinks
8. a) Type water supply: Public X Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions See map attached
b) Land area designated to building site
c) Sewage Disposal Contractor
garbage disposal
washing machine
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
July 21, 11987 W1111
Date Me a d e %9egAq_nja juAe
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: Lot is located in Bermuda Run as shown on the enclosed map.
I
e
Gin � P
U�
DCHD (6-82)
`'r
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
Bermuda Run_ (office use only)
Xow no 1. 1 am the owner of the above described property.
yes ffd 2. 1 am not the owner of the above described property, however, I certify that I
have consent from ff. A 4 L L Z$ , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes K& 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
w `
DATE SIGNATURE
Meade H. Willis
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
Owner only
Owners designated representative
Anyone requesting results
Only those listed below
Wac1/bviyjBar# & Trust Co., N.A.
Age t, a Wi is,Jr.
B
Vice Pres i e
7/21/87 �Y_/
DATE SIGNATURE
Meade H. Willis, Jr.
DCHD (11 /84)
ILIL s
16. Z
16
Ik
I
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170
40.
TZ 0.-
r,(' PIZ
AV
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION /
Name �;I�/�Ol' ��.' f 1, -� Datej��l
Address Lot Size
FACTORS AREA 1 AREA 2 1AREA 3 ARFA 4
5
6)
I)
9) Site Classification
1) Topography/ Landscape Position
PS PS PS PS
2) Soil Texture (12-36 in.) Sandy, - S
Loamy, Clayey, (note 2:1 Clay) S PS PS PS
3) Soil Structure (12-36 in.) S
Clayey Soils PS PS PS PS
d) Soil Depth (inches) S S
rS PS PS P
) Soil Drainage: Internal S,� S
PS S PS
External S
Restrictive Horizons
Available Space P PS (�S)PS
YJ" U
Other (Specify) S S S S
PS PS PS PS
U U U U
J�• � • J -
U—UNSUITABLE
Recommendations/ Comments:
Described by
SITE DIAGRAM
UCHD (6-82)
S—SUITABLpE PS—Provisionally Suitable
Title—, Date 41
�3
ys'
U—UNSUITABLE
Recommendations/ Comments:
Described by
SITE DIAGRAM
UCHD (6-82)
S—SUITABLpE PS—Provisionally Suitable
Title—, Date 41
�3
ys'
. ;
• Davie County �7lealffr Departineni
do
and me Nealtli .tel9" ne cy
21 O HOSPITAL STREET / P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
September 21, 1987
W. Clarence Goings
Wachovia Bank and Trust Co.
P. 0. Box 3099
Winston-Salem, NC 27150
Mr. Goings:
On September 21, 1987, this office evaluated lot 160 in Bermuda Run to
determine its suitability for the installation of a septic tank system.
On that date the back portion of the lot was classified provisionally
suitable. The front is unsuitable.
Before any permit can be issued the prospective buyer must fill out the
enclosed application and the house must be staked off.
If you have any questions, please call this office.
Sincerely,
R442.
Robert B. Hall, Jr., R.S.
Environmental Health
Enclosures
RH/wd
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT&j`
Soil/Site Evaluation
APPLICANT'S NAME DATE DATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE�yhJ
SUBDIVISION ROAD NAME Ae* d00 C, e `V- le
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring I Pit
Public
Cut
FACTORS
1
2
3 4 5 6 7
Landscape position
L_
Slope %
.51
HORIZON I DEPTH
/a "
Texture group
S
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLTTE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS: ' iq C
LEGEND
Landscaoe Position
R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope
CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H.- Head slope
Texture
S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt
SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C - Clay
CONSISTENCE
M is
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
Wet
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
Structure
SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralogy
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD (01-90)
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DAME COUNTY HEALTH DEPAWMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #: (336)751-8760
October 22, 1999 11
Kurtis Jon Keiser
251 Westridge Road
Advance, NC 27006'.
Re: Site Evaluation/Boxwood Circle
Tax Office PIN: #5882-05-0523
Dear Mr. Keiser:
As requested, a representative from this office visited the aforementioned site on
October 22, 1999. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the back of the lot was
found to be provisionally suitable for the installation of an on-site sewage system.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
A40t %e. 0?v4ax-
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
Enclosure(s)
Davie County Health Department
10 NV1
1836 Environmental Health Section.
P.O. Box 848
210 Hospital Street
TA Courier # : 09-46-06 1911
Mocksville, NC 27028
Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
Name: Phone Number (Home)
Mailing Address:(Work)
(\J Email Address: CA-,
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De fled Directions To IVPQ-� AYN L-A411901i� j4k ok Gi
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Property Address: 12'J'5 F&u)O0-DI oulk
Please Fill In The Following Information About The EXTSTING Facility:
Name System Installed Under: Type Of Facility:
Date System Installed (Month/Date/Year): ;?(003 Number Of Bedrooms:Number Of People:
'I s The Facility. Currently Vacant? Yes 6) If Yes, For How Long?
Any Known Problems? Yes If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility:_ Number Of Bedrooms: Number of People
Pool Size,-?O� 0 Gar ge L Size: Other:
—
Requested By: Date Requested: :2-
(Si ature)
Oents.
For Environmental Health Office Use Only
Disapproved
.Enviromnental Health Specialist Date: !yZ14M
*The signing of this form by the Environmental Health Stafois 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 Money Order # C?(60& Amount:$ -
Paid By: Received By:_
Account #: 97024 Invoice #:
Date:_
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COUNTY -BOUNDARY
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RAILROAD CENTERLINE
PARCELS
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DAVIE COUNTY
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***WARNING: THIS IS NOT A SURVEY!*** Monday, April 2 2012
This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded
deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public
primary information sources should be consulted for verification of the information contained on this map. The
County and mapping company assume no legal responsibility for the information contained on this map.