422 Danner Rd Davie County,NC Tax Parcel,Report Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
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Parcel Number: F400000005 Township: Clarksville
NCPIN Number: 5820876043 Municipality:
Account Number: 8305859 Census Tract: 37059-801
Listed Owner 1: HENDRICKS RICKY STEVEN Voting Precinct: CLARKSVILLE
Mailing Address 1: 368 DANNER ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 18.26 AC DANNER RD Fire Response District: WILLIAM R.DAVIE
Assessed Acreage: 17.56 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 3/2015 Middle School Zone: NORTH DAVIE
Deed Book/Page: 2015EO138 Soil Types: PaD,PcC2,EnB,RnD,MsC,ChA,CeB2,MsD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 12340.00 Outbuilding&Extra 770.00
Freatures Value:
Land Value: 96120.00 Total Market Value: 109230.00
Total Assessed Value: 35320.00
All data is provided as is without warranty or guarantee of any kind either expressed or Implied including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS websne shall hold harmless the
NCounty of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
C1. or arising out of the use or Inability to use the GIS data provided by this webs Re.
Permittee's i DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section 'PROPERTY INFORMATION
r , _ P.O. Box 848 a f Z . 2 ,. 43
Directions to property:�l��fl`1 �i M, ocksville,NC 27028 Subdivision Name:
(�� ►3►�✓i - � Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
t� SYSTEM CONSTRUCTION "
2263 3 A Road Name. :.
AUTHORIZATION NO:. 4 � 7P4�rJtc,�-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;ij h Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
,.ENV11�0NMETA HEALTH SPECIAQS DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE `#BEDROOMS �— #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFIATION: FACILITY TYPE�j #PEOPLE #PEOPLE/SHIFT� #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE aTYPE WATER SUPPLY. C.L DESIGN WASTEWATER FLOW(GPD) `y NEW SITE,_ REPAIR SITE
SYSTEM_SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH_ LINEAR Fr. IL
OTHER �1 � 1 z ' p� MS tJ le-
REQUIRED
idREQUIRED SITE MODIFICATIONS/CONDITIONS: I S`t4l j� GOIJ't Ott
IMPROVEMENT PERMIT LAYOUT
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"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:
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AUTHORIZATION NO. OPERATION PERMIT B DATE: Z O
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE M DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT'AND CERTIFICATE OF COMPLETION
*PtC1TE Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se agz✓ Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
_ v / � A
Namm+e t/ f� ,���ll/,���r ,�/ =%�'l/• Date
Location �//r /��.��i� �`.n/ �� f AIrX,%/P�� 1' ` -
Subdivision Name Lot No. Sec. or Block No.
Lot Size ��`�� House Mobile Home _ Business Speculation
No. Bedrooms � No. Baths No. in Family _
Garbage Disposal YES p NO
Specifications for System:
Auto Dish Washer YES NO ,0
Auto Wash Machine YES [ NO ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
g�
Improvements permit by
'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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
t � �- 11
T
.Certificate of Completion � Date � -2�
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'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE.:.;Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
, ,� ;
Name X 11� %1; ':'�1, Date _� l
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size /y,•',/' House �� Mobile Home _ Business Speculation
No. Bedrooms No. Baths _ _ No. in Family
Garbage Disposal YES ❑ NO 2-1�' Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES d NO fl ) x
Type Water Supply x✓"��f
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
.f
�r
Improvements permit by :� f
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion tate
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
' DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION "60
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME �bs ���1�-S PHONE NUMBER 49 Z SLfLo
ADDRESS Ll q,)- t')'Na ,r� CE) SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED 1105 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY 1`�`� NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING . ^�
DATE REQUESTED f INFORMATION TAKEN BY
1
This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev,1193
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