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421 Allen RdDavie Countv. NC � Tax Parcel Report Wednesday, October 12, 2016 WAKPIllV(s: �lrilD !l PIUl A JUKVLY Parcel Information Parcel Number: G300000082 Township: Mocksviile NCPIN Number: 5729384183 Municipality: Account Number: 73836000 Census Tract: 37059-806 Listed Owner 1: TRIVITfE BILLY W Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 421 ALLEN ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC 2oning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: Legal Description: 11.241 AC ALLEN RD Fire Response District: Assessed Acreage: 10.77 Elementary School Zone: Deed Date: 9/1989 Middle School Zone: Deed Book / Page: 001500631 Soil Types: Plat Book: . Flood Zone: Plat Page: Watershed Overlay: Bullding Value: 130800.00 Outbuilding 8� Extra Freatures Value: Land Value: 121520.00 Total Market Value: Total Assessed Value: 269980.00 9"�°'�' Davie County, �o��,�� NC WILLIAM R. DAVIE WILLIAM R DAVIE NORTH DAVIE PaD,PcC2,CeB2 DAVIE COUNTY 17660.00 269980.00 No , „. , ... , .,.,. , ,. ,, :_. __ : .. .... ... ,' . . AUTHORIZATION NO: DAVIE COUNTY HEALTH D �� ✓Xd EPARTMENT / • � - "' � '� � `� �j Environmental Health Section PROPERTY INFORMATION PermiJtae's ,,, �;f� �14i P.O. Box 848 Name: ' i1���Q— �'b4- �'r� �"G-r� �"�'-�����Mocksville, NC 27028 Subdivision Name: 4 Phone #: 704-634-8760 Directions to property: �a��+�(i�l-�t�,) '�f r� hc�t,^ Section: Lot: AUTHORIZATION FOR `�� , ���;L G;.� LcL � tlr o-•�,1 �,^r n, ;- WASTEWATER Tax Office PIN:#�� ?` - :�iV _ �� � SYSTEM CONSTRUCTION 1,�1 r� i: �- t? : r, n Road Name: t.i.t=.n� f i:> Zip: ��:? **NOT'E** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Envuonmental Health SecUon prior to issuance of any Building Pernuts. This Forn�/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S: Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ; �,,, � ,, � i� TH SPECIAi IST`; DATE �***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION � IS VALm FOR A PERIOD OF FIVE YEARS. . .. _ , ,,. _ ..__. , / / '; s ��' y� DAVIE COUNTY H . � `��� � _ `" ' EALTH DEPARTMENT � ���d ���� A• a� '"� �, `� �, TMPROVEMENT.AND OPERATION PERMITS PROPERTY INFORMATION � 4 Pei`'m��"- �'�" � � �.� e �_ �. -`•� �" N�� '�J ��� �'�-- ' T �- � ~°�����'• � �' �.`'� �� Subdivision Name: � _ � � � { '� Directions to property: � 1 '•t`; . �A�1 � - t ` 1l � �-t_� �} -,--Section: Lot: Il�IPROVEMENT �� � PERMIT F � J r. r. ;.� {... r � .. ,,, . ?- s, ;- ir'. �� k- �:- .. TaxOfficePIN:#`�' .%'� _ "��' ��i`�.,"' F �; ,� °* Road Name: ���1 � c h� ��� � Zip: a`? r� **NOTE** This Impmvement Pernut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained frc�m this Department prior to the construction/installatipn of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ._ x„_., ��' ``"`" % `� � "**NOTTCE*** TiII.S PERNIIT IS SUBJECT TO REVOCAITON IF SITE .�-.�=.., ��: ,;... �%;� -.----^�:` � J:-� � PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER 7 AL"H6'ALTH SBECIAi,IST�: Y DATE IS�SUED SYSTEM CONTRACTOR MUST SEE TEIIS PERMTI' BEFORE �-� � -� INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFTCATION: BUILDING TYPE �.Y� # BEDROOMS ? # BATHS � # OCCUPANTS �_ GARBAGE DISPOSAL es or No COMMERCIAL SPECIFICATION: FACILII'Y TYPE # PEOPLE # PEOPLFJSHIFI' # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE ��CYPE WATER SUPPLY �u-�- DESIGN WASTEWATER FLOW (GPD) �-✓�'� NEW SITE ►''" REPAIR SITE � ,� � SYSTEM SPECIFICATIONS: , TANK SIZE �GAL. PUMP TANK GAL. TRENCH WIDTH �` � ROCK DEPTH I Z-+' LINEAR FT. -�Q U OTHER � F:+�S�I�L�IR�TIrx� i7� '� n � 1 n p REQUIREDSITEMODIFICATIONS/CONDITIONS: ��S"I�ALI._ ��� ��ycJ� �j1'c-_�rr �.) f)F�- }�c:t�.� ��C(-t' �� C)F� `Pc;P. �1 � IMPROVEMENT PERMIT LAYOUT J �U� �' , �� �� **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 930 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT � AUTHORIZATION NO. __�r��� OPERATION PERMIT BY: /-Y G� DATE: /��� **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECI'ION .1900 "SEWAGE TREATMENT AND 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 OS/96 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT P �.� , r � ' Davie County Health Department ' Environmental Health Section � � P.O. Box 848 Mocksville, NC 27028 � / � (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed �s9� K P�a�' ��� Contact Person ��� b�� ��i `Q'`- Mailing Address V• S•/� �s'� Home Phone 9 9�' � r1 3 g City/State/Zip �} ci 1/�4 NC Q ��%� e• -2-�70 %�S 0� Business Phone /'nj �— �i3 3� 2. Name on PermibATC if Different than Above c� Fi M"�. Mailing Address �' ii' �"�'� ��� a,T� City/State/Zip 3. Application For: j�Site Evaluation �(] Improvement Permit & ATC [] Both 4. System to Serve: �Q House [] Mobile Home []� i�sg� ] Indpstry [] Other 5. If Residence: # People .3 # Bedrooms� # Bathroom�s_� [�jDishwasher [�'Garbage Disposal [j�}'�Vashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [] County/City � ell [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [i] No If yes, what type? E I THER A PLtIT OIl S Z ZE PLftN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **��fi OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: � 3 R C✓�' S � WRITE DIRECTIONS (from Mocksville) TO PROPERTI': Tax O�ce PIN: # � �� - 3 8 - �� S 3 � [9 a / /V o ,� �� 7�v /� /�e, �/ :'C� • Property Address: Road I�fame ,�1 � �c N l�C b+� � � �u v � / � t -I O r %� � � � �v i _ ! City/Zip /�vC/�yll L� /�/•C. �.7a:1$ � � o i� %E' �� V UtS� If in Subdivision provide information, as follows: ��j e o� e � N c� o� 1`C a�A ci ' � Name: � � � Section: Lot #: ; 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 �i 1� y 1 1' i✓C 7 f� to DATE Z' I�"" R�S SIGNATURE� Revised DCHD (06-96) T1�iIS ttREA a . v � � as necessary to determine the site suitability. $E USEb �OR bllrlLVZNC JOUn SZTE PLAN: n Na�a� �,�aKGS �m� i� , 1dlt�e (' - ,,,y,. .... l(Y � �; b 15u ���'sl i �y ��e � ' !R'��� I 1Y �P +. � � .� �' ��,�,�. r[.V- �� ys 4x i , � 7 A ,�� �i i� a',�.�.s5 .�, � �r . m'6 � t +� �r;.L *i �t 4 � . '��' �. y, � _ _ .. . � � � � .,; 4 ) � �. ��� ` � � � ,� � � �K'+f-; � T£ � 4' ���M� �� ` +� � � �'� ` .�u�r .� `' i ,�' �F3 (6�f�, '�'�',�} ('� � .,. y�., r � � t� f{ 4xy 4 t w; ^� , d� i ��r 71 �i� ,� ,. a. - V t���<., � P , r *f i � '� :�°� L� � ed '� '�,q�1 ``e ;' a �, ;� ��''�y , " tl .�' � f G.E� �--_. � /, .=� b b 1 ��.i. 1 � : ` Y f f ! �.� � b " 4 i "M � 1 11 a''_ 2!^f k {n � �� � .�, ' 1 ..'Y yi . _j f» •i. �v a . 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BOX B4e / Z�O HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 PHONe:(704)634-8760 March 5, 1998 Boger Real Estate 5248 U. S. Hwy. 158 Advance, NC 270�6 Re: Site Evaluation Al1en Road/13 Acres Tax PIN: #5729-38-4183 Dear Client(s): As requested, a representative from this oifice visited the aiorementioned site on March 4� 1998. Based upon the information provided on the application for site evaluation and aiter the evaluation was completed, the site vas found to be provisionally suitable for installation of an on-site ser�age disposal system. Ii you have any questions, please feel freE to contact this oifice. Sincerely, /" � �.�� " .• (�� r ` �'`r ., �._ �-�' T . ,, ,.' __ _ �_ Jeff G. Beauchamp� R. S:� Environmental Health Specialist JB/Wd Enclosure(s) � �