775 Cherry Hill Rd (2) Davie County,NC Tax Parcel Report ( 1pI Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information.
Parcel Number: M60000005304 Township: Jerusalem
NCPIN Number: 5755864526 Municipality:
Account Number: 82524570 Census Tract: 37059-807
Listed Owner 1: CLENDENIN JAMES A ETAL Voting Precinct: JERUSALEM
Mailing Address 1: 673 DEADMON ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 3.741 AC CHERRY HILL RD Fire Response District: JERUSALEM
Assessed Acreage: 3.67 Elementary School Zone: COOLEEMEE
Deed Date: 6/2005 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 006110097 Soil Types: PcB2,PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding 8r Extra 14490.00
Freatures Value:
Land Value: 31640.00 Total Market Value: 46130.00
Total Assessed Value: 46130.00
161
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County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or inability to use the GIS data provided by this website.
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RUTH l' zAT1oN No: ,q C DAVIE UNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION -R-Rg
Permittee' `��, '' _�` P.O.Box 848 10A
Name': Mocksville;NC 27028 , Subdivision Name:
f r d / `�� Phone"# 336-751-8760
Directions to property: 7,� �f r�" Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
Road Name: t r Zip:
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by`the Davie County,Environmental Health Section prior
to issuance of any Building-Permits.This Form/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)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
0171W IS VALID FOR A PERIOD OF FIVE YEARS:
ENVI ONMENTAL HEALTH SPECIALIST DATE.ISSUED
1 •��" .. �.r,.-v� .W` •t"�X'Yt7a:hT { .x, �. '+ ,,- ... .< u,-:i "ra,..
16 7 . DAVIE. OUNTY;HEALTH DEP� XNT -
PROPERTY INFORMATION }�
IMPROVEMENT AND OPERATIO S .C�-qy
Permilxes
'Name:- 'I �, a �'tllil Subdivision Name:
Dlrectionsto,property: f.. '�`�/ ' � Section: Lot:
IMPROVEMENT �-+��
PERMIT Tax Office PIN:#� / _
Road Name: !fit
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation 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 1 l of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
f�: -✓,r' ", r ***NOTICE***THIS PERMIT IS SUBJECT:TO REVOCATION IF SITE-
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
-ENV ONMENTAL HEALTH SP C— I DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
_ INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS_�#BATHS_ #OCCUPANTS _GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY-� DESIGN WASTEWATER FLOW(GPD),:,�` NEW SITE—Z/REPAIR SITE
SYSTEM SPECIFICATIONS:TANK SIZE, QUO GAL. PUMP TANK GAL. TRENCH WIDTH�G ROCK DEPTH _ LINEAR FT.
OTHER .
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
I
AD
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.1
OPERATION PERMIT
SYSTEM INSTALLED BY:
_ y
AUTHORIZATION NO.-t-'+F`-' —=OPERATION PERMIT BY: DATE: ` b.
*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THATTHE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE .
WITH ARTICLE 11 OF G.S.CHAPTER I30A,SECTION.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 05/96(Revised) -
APPLICATION FOR SITE EVAWATION/IMPROVEMENT PERMIT&ATC � � �' O M rc►
Davie County Health Department U L5
Enviroamenfa/Hea/Hh Section
P.O. Box 848/210 Hospital Street SEP 2 5 199
Mocksville, NC 27028
(336)751-8760 ENVIRONMENTAL HEALTH
DAVIE COI)NIX
***IIWM!rANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the
1 INFORMATION BULLETIN for instructions. ,,/In',,
i. Name to be Billed L YL_ S 0, (L-✓� d10 io It Yl Contact Person ��DYe'S I .I1�{�(�Li�' 11 0
Mailing Address Ha®e Phone
, / f '1 . 33&- 99A- 45 b
/ •/ � (� YI(°_1�1/T�•� � /
City/state/ZIP ���� l�, �_ ,/ (� � � Business Phone- / VI/
/,
2. Name on Permit/ATC if Different than Above__ W1t� .
!!ailing Address Yy) City/state/Zip �Q me ,
3. Application For: 'Site Evaluation 0 Improvement Permit/ATC r Both
4. system to Service: 0 House Mobile Home 0 Business 0 Industry 0 Other
a. If Residence: # �Pefople r�1y� # Bedrooms �1�� # Bathr�loomsyj�_
0 Dis=UIS' 0 Garbage/vDDispossal 0 Wa"shin0 g Machine 0 Bas' t Plumbing 0 8 mat jNoelunbing
6. If Business/Industry/other: Specify type # People # sinks
# Commodes # showers # Urinals # Nater Coolers
IF FOODSERVICE: (i Seats Estimated hater Usage (gallons per day)
7. Type of water supply: 0 County/City 0 Well 0 Comnmity
a. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes )(No
If yes,what type?
***IHPIDRTANT***CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAtITTED by the client with THIS APPLICATION.
Property Dimensions: J, q A� a C j,-e-,S WRITE DIRECTIONS(from Mocksviile)to PROPERTY:
Tax Office PIN: # _S'"15ti — (o - '7 ` �/OOO fr D In ,� D 15 C D m e
Property Address: Road Name l.h eYY\/ *,)I ) Ku, (S�-V'e-^A <V J +A Y-M
City/tip W-(9L S o('j )e- 2102t e, 0 n I o
If in a Subdivision provide information,as follows: 1'Y n rn 161 A 'TtAYn all 4D
Name: ,Ci�1�y V�I All a , at)
Section: Block: Lot: Date Property Flagged: 4-- DA " 15
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 responsiblefor 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— — -- f 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).
Account No.
Revised DCHD(07/98) Invoice No.
4 At' ,,._9,23Ac 15.
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