1233 Howardtown CircleHEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848,
Mocksville NC 27028'
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Sharon Ebright .
Address: 1233 Howardtown Circle
City: Mocksville
State2ip: NC 27028
Phone M (336) 448-8400
For office Use Only
?*CDP File Number ;190703 -1
County ID Number:
Evaluated For. HDR/WWC
PERMIT VALID 6 a/ 0 9/ a 0 a 0
UNTIL:
11�-
Property Owner: Sharon Ebright
Address: 1233 Howardtown Circle
City: Mocksville
State2ip:
Phone #:
NC 27028
(336) 448-8400
/"— Property Location & Site Information
Address 1233 Howardtown Circle Subdivision: Phase:
Road# Mocksville NC 27028
SINGLE FAMILY Township:
'Structure: Directions
# of Bedrooms: 3 # of People: Hwy 158 right on Howardtown Circle
"Water Supply: PIA
Basement: Fj Yes D No Type of Business:
Total sq. Footage: No. Of Employees:
"Proposed Improvement:
Livingtonroom/den
Lot
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
.system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? OYes ONo
Applicant/Legal Reps. Signature: *Date: /
*Issued By: 2140 - Nations, Robert
*Date of Issue: 0 -1 / 0 9/ 2 0 1 5
Authorized State Agent: !9 �1
**Site Plan/Drawing attached.**
d9Hand Drawing O l mport Drawing
Davie County Health Department
iI Environmental Health Section;..
a P.O. Box 848E E'!1
210 Hospital Street C VVI
(� • „ Dai. D -- F
C� dew: Courier # : 09-40-06 _ ;. '.
Rpeewea`D ` Mocksville, NG 27028
Phone: (336) - 753 - 6780 Fax: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: Eb (1 Phone Number ome)
Mailing Address: `93 --11 `( - (Work)
Email Address:. cA6.2[ P ik aWwQ'd�Yl
Detailed Directions To Site: M NIV*x r` k AA x. tft f 1AJ Q kAU '\'3,�XOh
Property Address: C 0
Please Fill In The Following Information About The EXfSTJNq Facility:
Name System Installed Under: Gl ype Of Facility:_ _hrn0
Date System Installed (Month/Date/Year): Number Of Bedrooms:_ Number Of People:
Is The Facility Currently Vacant? Yes If Yes, For How Long?
Any Known Problems? Yes ® If Yes, Explain:
Please Fill In The Following Information About The NiXNumber
Facility:Type Of Facility: Of Bedrooms: Number of People_
Pool Size: Garage Size: Other: 30 )C
Requested By: 1(1 ( Date Requested:
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should betaken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for. any given period of time.
Check Money Order #.
Amount: $
Paid By: Received By:_
Account #: �Q 6�L� Invoice #:
s Printed:Jan 26, 2015
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.
DIED BOOR_ Lff---- 11-
alta Ma amlxrnr7Y111
O38 July 1996 10:07 A.M.
94
MW I OM aGISIER Or GELDS
r40 THAM CONSIDERATION STATED
Assistmt
Excise Tax Recording Time, Book and Page
TaxLot No . .......................................................................................... Parcel Identifier No . ..........................................................................
Verifiedby ............................................. .......................... County on the ................ day of ........................................................1 19 ............
by..............................................................................................................................................................................................................................
Mail after recording to .... TArrY..H0bert..H0Var.d ..................................... ...... ...... * .............
1233 Hawardtown Circle, Mocksville, NC 27028
................................................................................................................. . ................................ ................................................................................
This Instrument was prepared byGrady--L,--MCC1a=0 . ck Jr., ., .... 161 ... South.. Main -Street -i --MocksvijleiNC"'****
Brief description for the Index F
NORTH CAROLINA NON -WARRANTY DEED
THIS DEED made this 9 day of ........................ MY ...................... 19..9.6#....., by and between
GRANTOR GRANTEE
PATRICIA A. HOWARD LARRY ROBERT HOWARD
(separated) (separated)
Enter in appropriate black for each party: name, address, and, if appropriate, character of entity, eq. corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and
shall include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which Is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the, Grantee in fee simple, all that
certain lot or parcel of land situated In the City of .............................................................. ............. Fj3jjLjdngtm .......... Township,
...................... Daide .................. County, North Carolina and more particularly described As follows:
SEE ATTACHED SCHEDULES "A"# "B" AND "C"
DEED TRANSFER CHECKED
LATE 7'd -e1;(,
N. C. R., Aa .Form N..7 0 1977 - m..,- a M.,Ob
hl.W b, ly— ---N. C. — — - INS
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