612 E Lexington Rd (2) Davie County,NC r Tax Parcel Report Friday, December 16, 2016
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Parcel Informata on
Parcel Number:', -J50000003204 Township: Mocksville
NCPIN Number:—,-, _`5748010989 Municipality: MOCKSVILLE
Account Number:,--.- 8302041 Census Tract: 37059-805
Listed Owner-l: =-t• CAMERON DAVID J; Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1:.: ;612 EAST LEXINGTON ROAD Planning Jurisdiction: MOCKSVILLE
City: MOCKSVILLE Zoning Class: MOCKSVILLE NR,GR
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 6.56 AC HWY 64 '_ : Fire Response District: MOCKSVILLE
Assessed Acreage: 6.29 Elementary School Zone: MOCKSVILLE
Deed Date: _ 3/2013:: Middle School Zone: SOUTH DAVIE
Deed Book/Page: 009200115 Soil Types: MrB2,CeB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: MOCKSVILLE
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
161
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 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
NC or arising out of the use or Inability to use the GIS data provided by this website.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
a�tary Sewage SXs �Ims y� Permit U rb�er
Name' "' ' U �i'J��6 ✓/il/�/��' ate NO � G
Locatio /
Subdivision Name Lot No. Sec. or Block No.
Lot Size �lIC House `Mobile Home _T Business Speculation
No. Bedrooms J No. Baths No. in Family _
Garbage Disposal YES ❑ NO 1� Sp cificat ions for Sstem: .
Auto Dish Washer YES N0 S -
Auto Wash Ma:hive YES NO ❑ `/ �!
Type Water Supply,
*This permit Void if sewage system described below is not--iftstaJfleditin 5 years from date of-issue.
This permit is subject to revocation if site plans or then u hanZj
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
c
Certificate of Completion Date
'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
a IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
;,NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems',. Permit.uur b r
Name//,),X( `'vc,.r/ f Date 0
Locatio ....../1W
"
t' J
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 ❑ NO Sp cifications ;gr System:
Auto Dish Washer YES NO ❑ xv
�;a�>
Auto Wash Ma shine YES t] ` NO ❑
Type Water Supply „
'This permit Void if sewage system described belo is not 'n 5 ears from date of issue.
P 9 Y Y
This permit is subject to revocation if site plans or the inT#nde J-9 e, h a n-g .
d• 1 ,
Improvements permit by All
'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 _moi r
h
l�
S 111
'a
Certificate of Completion Date
'_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
,Pe
for any given period of time.
' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By
Mailing Address- ? 0. 4 On- ' f- Home Phone /04. 4 Z J
Business Phone
2. Name on Permit if Different than Above
3. Application for: ❑General Evaluation Cligoe'ptic Tank Installation Permit
4. System to Serve: [ 'House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home:Subdivision Section Lot #
❑ Basement/Plumbing
No.of People Z ❑ Basement/No Plumbing
No. of Bedrooms `4 ❑ Washing Machine
No. of Bathrooms 3 ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No.of Showers Water Usage Figures
7. Type of water supply: ❑ Public Q'Private ❑ Community
8. Property Dimensions.— Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes,what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
pp�
1°
This is to certify that the information provided is correct to a st of my knowledge,and I understand I am responsible for all charges
incurred from this application.
Q
DATE SIGNATURE
C NSENT FOR aLTE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD'(1193)