2601 Liberty Church RdDavie County, NC Tax Parcel Report Friday, October 7, 201(
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Parcel Number:
NCPIN Number:
Account Number: -
Listed Owner 1: DICKEN;
Mailing Address 1: 2601 LIBEI
City: YADKINVILLE
State:
Zip Code: 2705
Legal Description: 9.01 AC LIBER1
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
( 2493
2479 1}
2471
144 1 18
`- OLLIE EJINRKEY. RD
WARNING: THIS IS NOT A SURVEY
Davie County,
NC
Parcel Information
B200000001
Township:
Clarksville
5803497469
Municipality:
21084000
Census Tract:
37059-801
ROBERT LEE
Voting Precinct:
CLARKSVILLE
tTY CHURCH ROAD
Planning Jurisdiction:
Davie County
Zoning Class: DAVIE COUNTY R-A,R-20
NC
Zoning Overlay:
i-0000
Voluntary Ag. District:
No
Y CHURCH RD (5.45 AC)
Fire Response District:
LONE HICKORY
5.45
Elementary School Zone:
WILLIAM R DAVIE
12/1985
Middle School Zone:
NORTH DAVIE
001290335
Soil Types: MnC2,MnB2,MdC
11
Flood Zone:
197
Watershed Overlay:
DAVIE COUNTY
89300.00
Outbuilding & Extra
1610.00
Freatures Value:
32880.00
Total Market Value:
123790.00
123790.00
t V f
9
` iti u
�CUN��
Davie County,
NC
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.
• Well Construction Permit
�„• Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Property Owner= Evelyn Diane Dickens
Address: 2601 Liberty Church Road
City: Yadkinville
State/Zip: NC 27028
Phone #: (336) 492-7549
For Office Use Only
*CDP File Number 123396
PIN Number: 5803497469
Tax Lot n: Tax Block #:
Evaluated For: NEW
PERIJIT VALID UNTIL: 11/25/2018
Applicant: David Beck
Address: 156 Pepperstone Drive
City: Mocksville
State/Zip: NC 27028
Phone #- (336).492-7549
Property Location & Site Information
/Address/Road #: Subdivision:
Liberty Church Road
Yadkinville NC 27055
Site Address: Liberty Church Road
Phase: Lot:
*Proposed use of Well:
Directions If Other:
Directions: US Hwy 601 North, turn left on Liberty
Church Road. Then left on 011ie Harkey road, beside
Church. Property second Drive on Right.
Well Contractor Information
Drilling Contractor Driller Registration
Co
,,,,,,,,,,,,,,,,,,,,,
geou± 6-n
Permit Conditions
'Permit Conditions
Well location, instalation, and protection must meet all state and local regulations and must be inspected and approved by an authorized representative o
the local Health Department, the permit may be revoked at anytime for failure to comply with existing regulations The siting of the well by the Health
Department is to provide protection from the kn=n possible sources of contamination. The well site may not be changed without .vntten permission from
an authorized representative of the Local Health Department. No volume or quality of water is guaranteed by the Health Department
`Issued By: 2244 - Daywalt, Andrew *Date of Issue: 1 1 / 2 5 / 2 0 1
Authorized State Agent:C�� ** -Hand Drawing 0Import Drawing
Site Plan/Drawing attached.
1� WELL CONSTRUCTION PERMIT
Davie County Health Department
�o�.srnr;
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Type: Well Permit
361
1,4
CDP File Number: 123396
County File Number: 5803-797469
Date: 11 /25/2013
Qlnch
Scale: QBlock
() N /A
' `IP 1 1 f
6,1')
APPLICATION FOR PRIVATE WELL PERMIT
AZA 13 d Davie County Environmental Health
P P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336)751-8786
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
ame to be Billed--S:)°,V, AUC' C�L Contact Person—\ -)ay.' d Ze-C k
illing Address�`j�7)f Nve. Home Phone 336-L101a - to551
ity/State/ZIP ()a-Ccksv A\ e , IA -C i, Business Phone 33L51- cto g - O S
nail e
ame on Permit if Different Wan Above
PROPERTY INFORMATION *Date House/Facility Corners Flagged
OTE: A survey plat or site plan must accompany this application. Included: ite Plat (to scale)
Owner's Name F -\j r\ -D;izz-Ac., rjS Phone Number�33(o-qq a-75u�
Owner's Address,21401 U1necJ�3 0j1urCh iLr�atl City/State/Zip �p,t,1 k nyille. n_(. Q7055
Property Address_�)Vao\ L;bxcLxA Cnutch (CegA City riy 11
Lot Size R, I1 Tax PIN# _C K- �u o1
Subdivision Name(if applicable) Section/Lot#
Directions To Site: � g)C1 Or)f- -1 ACb tr t,; A cin Utiet �`�C-kru-) (Load AA--e-n
o a l ober v.fCln r -i n9 Or 6
DEVELOPMENT INFORMATION
Permit Type: New Well ✓ Well Repair Well Abandonment Other (specify)
Facility Type: Residential -,,/' Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES NO I, --
Do You Intend To Install A New Septic System On This Site�Y__� NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and comers. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terns and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine the best location for a well.
C(- g- X013
Signed Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
i 20 ns
. --7f—t�
144