1505 County Home RdZip Code:
I
27028-8139
WARNING: THIS IS NOTA SURVEY
No
Legal Description:
LOT 2 MORRIS & HENDRIX SECTION 1
Fire Response District:
MOCKSVILLE
Parcel Number:
J400000002
Township:
Mocksville
NCPIN Number.
5728613113
Municipality:
SOUTH DAVIE
Account Number:
82514234
Census Tract:
37059-801
Listed Owner 1:
RUTHERFORD ROBERT DAVID
Voting Precinct:
SOUTH MOCKSVILLE
Mailing Address 1:
1505 COUNTY HOME ROAD
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
I
27028-8139
Voluntary Ag. District:
No
Legal Description:
LOT 2 MORRIS & HENDRIX SECTION 1
Fire Response District:
MOCKSVILLE
Assessed Acreage:
0.92
Elementary School Zone:
MOCKSVILLE
Deed Date:
1/2000
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
003230046
Soil Types:
MrB2,MsC
Plat Book:
0004
Flood Zone:
X
Plat Page:
025
Watershed Overlay:
WS -IV -P
Building Value:
71830.00
Outbuilding & Extra
0.00
Freatures Value:
Land Value:
20000.00
Total Market Value:
91830.00
I
Total Assessed Value:
91830.00
o�vrF All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
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harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
°r� r causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
Permitter' E COUNTY HEALTH DEPARTMENT�� �� y
Name:
A,t�T-4vwl Environmental Health Section PROPERTY INFORMATION
7 / P.O. Box 848 .
. ,. Direcixons to property: { ��� ` f w"%%3� Mocksville, NC 2.7028 Subdivision Name:
1 � Phone #: 336-751-'8760
6 %�i`' Section:
Lot:
r AUTHORIZATION FOR
WASTEWATER -
f� t: SYSTEM CONSTRUCTION Tax Office PIN:#
AUTHORIZATION NO: A Road Name: 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE***,THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS _ # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes orNo
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE } REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. ;TRENCH WIDTH ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**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.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION N0.OPERATION PERMIT BY: DATE: /
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICA HAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, 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 02102 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME b�-`�� PHONE NUMBER ( 7 /7
ADDRESS C 5 C - SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE/� �.r o �/ �-L ^� 0j Se-
o-� 1•-Q-- fid' � f , `(,�, �.-a--� �) , �-��-�.
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED 3
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING—4 1-r'a
ll i
4,
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that 1 understand I am responsible for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT,
Rev. 1193