2868 Hwy 158A Zll1"i
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'Davie County Health Department
Environmental Health Section
Phone: (336) - 753 - 6780
Name: S o ►�
P.O. Box 848
210 Hospital Street
Courier # : 09-40-06
Mocksville, NC 27028
C60
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
NWA,SCM,t. R(J sfS115
1911
Fax: (336) - 753-1680
Phone Number (Home)
Zy0-bo9q C- 33(, -q -70-90-7(o (Work)
Email Address: �n�; �� e 112 g �-q oo • C o
Detailed Directions To Site: Llo ^ 1— TO Farr11.11C,ja.1 Rel• ek.*k — P. -.4f oti
1%ojse- ; s dA +4e - (Aa -- cwort cf oCr Ro:.4i,
Property Address: '284W VS,
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility:
Date System Installed (Month/Date/Year):,
Number Of Bedrooms: ) Number Of People:
Is The Facility Currently Vacant? Yes (jD If Yes, For How Long?
Any Known Problems? Yes (S)If Yes,
2
Please Fill In Th ollowing Information AboutIrdd'4
Facil-i
Type Of Facility: % i f' "-'QA) &Yll ' al�umber APd000ms: L Number of People 2
Pool Size: e Garage Size: Other:
Requested By L�� A- �
/. Date Requested: /0 - 2- 5-11
(Signa re)
For Environmental Health Office Use Only
Approved Disapproved
Environmental Health Specialist
Date:
*The signing of this form by the Environmental Health Staff is Who way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cap6 Chec4 Money Order # 31 qg Amount:$ 10b "V Date: (0/2shl
Paid By: �24ZV1'C1-41''K Received By: �n• m l �(JnQ `�
Account #: 5773 1 Invoice #:_ l�jZli
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Parcel #: G500000065
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Davie County, NC - Basic Estate Search
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Parcel #:G500000065
Account #:82532908
Owner Information
67,8701
Tax Codes
MITCHELL JASON MICHAEL & MITCHELL MARY UTLEYE
Land:
ADVLTAX - COUNTY T
868 US HWY 158
106,86g
READVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Deferred:
Property Information
Improved
Township
nd (Units/Type): 1.370 AC
00828
MOCKSVILLE
ddress: 2868 US HWY 158
2010 WD
Deed Information
Improved
Local Zonin
Date: 12/2015 Book: 01007 Page: 0758
01007
0758
lat Hook: 10 Page: 353
2015 WD
Le al Description
Improved
PIN
1.37 AC HWY 158
00862
5840954004
Property Values
Book
Buildin :
67,8701
BXF:
10,75
Land:
28,2401
Market:
106,86g
essed•
106 86
Deferred:
Unqualified
Sales Information
No.
Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
1
00788
0273
04
2009 WD
Unqualified
Improved
0
2
00828
0616
06
2010 WD
Unqualified
Improved
0
3
01007
0758
12
2015 WD
Unqualified
Improved
149,000
4
00862
0665
06
2011 WD
Qualified
Improved
125,000
5
00994
0862
07
2015 WD
Qualified
Improved
75,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Page 1 of 1
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000rili-11.
Davie County Web Site
All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be
consulted for verification of the Information. All information contained herein was created for the Davie County's internal use. Davie County,
its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
Implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsneVView.aspx?prid=1006572 6/8/2016