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D'avie County,NC Tax Parcel Report V Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
= Parcel Information � T .•.._W_��_«..__..,m _ -_ _.
Parcel Number: J606OA000901 Township: Fulton
NCPIN Number: 5757892956 Municipality:
Account Number: 82520062 Census Tract: 37059-804
Listed Owner 1: LEE DAVID E Voting Precinct: FULTON
Mailing Address 1: 175 CEDAR RIDGE ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay: -
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: LOT 1 JANICE M BOX PROP Fire Response District: FORK
Assessed Acreage: 0.96 Elementary School Zone: CORNATZER
Deed Date: 1/2003 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 004600515 Soil Types: GnB2,MsD
Plat Book: 0008 Flood Zone:
Plat Page: 003 Watershed Overlay: DAVIE COUNTY
Building Value: 122800.00 Outbuilding&Extra 9610.00
Freatures Value:
Land Value: 23400.00 Total Market Value: 155810.00
Total Assessed Value: 155810.00
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Davie County Health Department
q16 Environmental Health Section
9 P.O.BOX 848
210 Hospital Street JI
i Courier# : 09-40-06
U Data' Mocksville,NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: D a, VId 5, Q Phone Number 376 — V-0^p_�50S (Home)
Mailing Address: a- a �-)3-3 7'D 07 S (Work)
AQ ek:i v1,�e oc g Email Address: ,� :� 1514-8 ( cya h w,cc&,k
Detailed Directions To Site: ow kx V1//to �'�� "cl r/e/�GY' Z
(M /r C�u a t-lrl PT_�� Zee�"/t oto �c�.d A Grimm 17�a( i --A
Property Address: (�P 0r
Please Fill In The Following Information About The EXISTING Facility:.
Name System Installed Under: Zee, Type Of Facility:
Date System Installed(Month/Date/Year): e 0 03 Number Of Bedrooms: Number Of People:_
Is The Facility Currently Vacant? Yes If Yes,For How Long? -
Any Known Problems? Yes To)If Yes,Explain:
Please Fill In The Following Information About The NEWFacility:
Type Of Facility: D� i (/ Number Of Bedrooms: Number of People
Tool Size: Garage ize: �OXI fo Other: G /
Requested By: Z�kg� Date Requested:
ignature) .
For Environmental Health Office Use Only
Disapproved / -
9Cents. /� G� elil
Environmental Health Specialist ate:
*The signing of this form by the Environmental ealth Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function pr perly for any given period of time.
Payment: Cash Check Money Order # Amount:$ IV Date:
Paid By: Received By:
Account#: Invoice#:
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