1478 Country Home Rd (2)3avie Countv. NC Tax Parcel Report Friday. October 7. 201 f
Parcel Number: J301
NCPIN Number:
Account Number: .
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description: 25.00 AC TRACT
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WARNING: THIS 1S NOT A SURVEY
Parcel Information
X0005201
Township:
Mocksville
'28721778
Municipality:
Census Tract:
37059-801
Voting Precinct:
SOUTH MOCKSVILLE
Planning Jurisdiction:
MOCKSVILLE
Zoning Class: DAVIE COUNTY,
MOCKSVILLE R-A,OSR
Zoning Overlay:
Voluntary Ag. District:
No
i COLLETTE CORP.
Fire Response District:
MOCKSVILLE
25.00
Elementary School Zone:
MOCKSVILLE
6/2013
Middle School Zone:
SOUTH DAVIE
009300415
Soil Types: GnB2,GnC2,EnB,RnD,ChA,CeB2,MsD
11
Flood Zone:
200
Watershed Overlay:
DAVIE COUNTY, MOCKSVILLE
89720.00
Outbuilding & Extra
13020.00
Freatures Value:
Land Value: 102380.00 Total Market Value: 205120.00
Total Assessed Value: 205120.00
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Davie County,
NC
NC
All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
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
or arising out of the use or Inability to use the GIS data provided by this website.
,
Well Construction Permit
aDavie County Health Department
cr210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Property Owner: Farren Kent Shoaf
Address: 1438 County Home Rd
City: Mocksville
State/Zip: NC 27028
Phone M
(704) 902-9640
For Office Use Only
*CDP File Number 121743
PIN Number: J3-000-00-052
Tax Lot #: Tax Block #:
Evaluated For: WELL — —
VtKMI 1 VHLIU UN I IL: WZU/LUI`J
Applicant: Farren Kent Shoaf --:::I
Address: 1438 County Home Rd
City: Mocksville
State/Zip: NC 27028
Phone M. ��704)�102-96�40
Property Location & Site Information
/'Address/Road #: Subdivision:
1478 Country Home Rd
Mocksville NC 27028
Site Address: 1478 Country Home Rd
Phase: Lot:
*Proposed use of Well:
Directions If Other:
Directions: Pass Ingersoll Rand, pass Detention Center
property on right
Well Contractor Information
Well location, installation, and protection, must meet all state and local regulations and must be inspected and approved by an authorized representative of
the Local Health Department, the permit may be revoked at any time for failure to comply with existing regulations. The siting of the well by the Health
Department is to provide protection from the known possible sources of contamination. The well site may not be changed without written permission from
an authorized representative of the Local Health Department. No volume or quality of water is guaranteed by the Health Department.
*Issued By: 2140 - Nations, Robert *Date of Issue; 0 , 6 , / , .2 , 0 /,.2,0j,4
Hand Drawing O ImportDrawing
Authorized State Agent. **Site Plan/Drawing attached.**
Page 1 of 2
Characters
Remaining
4000
WELL CONSTRUCTION PERMIT 121743
e�q Davie County Health Department CDP File Number:
210 Hospital Street J3-000-00-052
P.O. Box 848 County File Number:
-4 Mocksville NC 27028 Date: 06 /.2 0/.2014
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Drawing Type: Well Permit Scale: , O Block
N/A
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Page 2 of 2
P1 P3
QLAM
WELL CONSTRUCTION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville
NC 27028
CDP File Number:
County File Number:
121743
J3-000-00-052
Date: .0.6. / a 0/ a 0 14
Drawing Type: Well Permit
Page 2 of 2
P1 P2
APPLICATION FOR PRIVATE WELL PERMIT "i �� 60
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336)753-1680 `
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
k
APPLICANT INFORMATION
Name Gt, /�v�� �D Contact Person Y'V-G0 Sy
Addres Home Phone 70 S/ Q D, 15:(,, qD
City/State/ZIP fig U C is t %f f •C. D Business Phone -?jI, 7 S-/ 113 -M-
Name on Permit if D/i ferent than Above
Mailing Address 7/—? % c—,,- -40 City/State/Zip _ /1710
PROPERTY INFORMATION .*Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must acco pany th' application. Included: ❑ Site Plan ❑Plat (to scale)
Owner's Name C,C 1�'e J d 4 Phone Number%P L/ l�b� yZ
Owner's Address G/ Z:' --4V0 12 City/State/Zip�_� U Gk Ui _? il%G .J70
Property Address �/ �' G 6 y d �✓\ City�j e (A "Z/{
Lot Size ';� S' C -t'4-6 Tax PIN#
Subdivision Name(if applicable) Section/Lot#
Directions To Site:
DEVELOPMENT INFORMATION
Permit Type: New Well ,V Well Repair Well Abandonment Other (specify)
Facility Type: Residential Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES NO
Do You Intend To Install A New Septic System On This Site? YES 'y`� NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform. necessary field evaluations and procedures deemed necessary to
determi e the best location for a 11.
601-
Signe Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
7/30/09 Account #
Invoice #
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