2074 Hwy 601N (3) DAVIE COUNTY HEALTH DEPARTMENT
\n V Environmental Health Section
V� Box 0 Hospital 0�
PO ox 848/71Street
Mocksville,NC 27028
OOOJJI��a 'Phone: (336)751-8760 t
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ON-SITE WASTEWATER CERTIFICATION FO DWELLING
(Check One) ,REPLACEMENT❑ "REMODELING A7 RECONNECTION ❑
NamdSct L�_ Al a -Phone Number:336 4/q Z 5 5 y (Home)
Mailing Address: .2 D 7 66 Ale,, (Work)
Detailed Directions To Site:4i2 I N D
PropeAddress: 2-0 7` 6 6 / /yo, 7
Please Fill In The Fo owing Information About The Existing Dwelling.
Name System Installed Under: Type Of Dwelling: t�� � s� G •'()
Date System Installed(Month/Day/Year): L�-, 06V-3,f Number Of Bedrooms:. Number Of People:
Is The Dwelling Currently Vacant? Yes,6 No❑ If Yes,For How Yong?
Any Known Problems?Yes❑ Nod If Yes,Explain:
`34A a /s
Please Fid• In The Following Informatia►n About The New Dwell'ng:
Type Of welting: t AL ms:� Number Of People:
Requested By: Date Requested:
(Signature)
For Environmental Health Office Use Only
APProved Disa roved ❑
PP
Comments:
Environmental Health Specialist Date
l
*Tbe signing of this form by the Environmental Health Staff is in no 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: Cashpr°Check❑ Money Order❑ # Amount: $ 107),&, , Date: lc? 3 -07
r
Paid By:: Received By:
Account #: Invoice #:
Davie County,NC Tax Parcel Report Tuesday,August 9,2016
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WARNING:THIS IS NOT A SURVEY
Parcel Information
Parcel Number: G400000058 Township: Mocksville
NCPIN Number: 5820604050 Municipality:
Account Number: 82514596 Census Tract: 37059-806
Listed Owner 1: WALL TIMOTHY R Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 2074 HWY 601 NORTH SUITE 100 Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-M,H-B,1-3-S
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 5.539AC TR 2 FOSTER S/D Fire Response District: WILLIAM R.DAVIE
Assessed Acreage: 5.48 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 11/2007 Middle School Zone: NORTH DAVIE
Deed Book/Page: 007370056 Soil Types: PcC2,CeB2
Plat Book: 0008 Flood Zone: X
Plat Page: 387 Watershed Overlay:
Building Value: 112220.00
Outbuilding S Extra 25900.00
Freatures Value:
Land Value: 205500.00
Total Market Value: 343620.00
Total Assessed Value: 343620.00
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