115 Potters Ln r` -��
Davie County,NC � T�Parcel Report Wednesday, October 5,2016
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WARNING: THIS IS NOT A SURVEY
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Parcel Information
Parcel Number. F400000016 Township: Clarksvilie
NCPIN Number: 5831100151 Municipality:
Account Number: 18201500 Census Tract: 37059-801
Listed Owner 1: COUCH SUE B Voting Precinct: CLARKSVILLE
Mailing Address 1: 115 POTTERS LANE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Ciass: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.Dlstrict: No
Legal Description: 8.03 AC CANA RD LIFE ESTATE Fire Response District: WILLIAM R. DAVIE
Assessed Acreage: 7.62 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 4/2012 Middle School 2one: NORTH DAVIE
Deed Book/Page: 008890068 Soil Types: Mr82,Gn82,EnB,GaD,MsC,ChA
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 262150.00 Outbuiiding 8�Extra 15810.00
Freatures Value:
Land Value: 62570.00 Total Market Value: 340530.00
Totai Assessed Value: 340530.00
9��t, All data is provided u Is wRhaR vrarraMy or guarantee of any Idnd elther expressed or Implied induding but not Iimked to the
Davie County� Implled wamMles of inerchantabllity orfltness tw a particular usa Ail users o/Davie Courrt�s GIS webske shall hold hartnlep the
CourAy oT Davie,Nortb Carolina,ks agents,consuka�Rs,coMnctors w employees from any and ap dafms or wuses of actlon due to
�'pu N.�� NC or arlsing out ot the uu or Ina611tty to use fhe GIS data provlded 6y fhls webstta
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Davie County Health Department �
�o�s f fi Environmental Health Section � ;;;. .
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:, � ~� . 210 Hospital Street ��� a
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O U, ��, Courier# : 09-40-06 � .
Mocksville, NC 27028 �
Phone:(336)-753-6780. Fax:(336)-751-8786
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
� (Check One) Replacement Remodeling Reconnection �
Name: � v L Phone Number v��� —l7 � �d (Home)
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MailingAddress:_7/.'�'-6`�1�i72-7�{$ ��l/ ` �'3�l c�'t> "J��3� (Work)
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. �'/�C�c!/.LLC . �,Cvd27o�� Email �
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Detailed Directions To Site: � d / /" � �/l�x/�. � ' � /?i �c—'� ��L Gr�
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Property Address:_/��_Q �� � ��� , �
. Please Fill In The Following Information.About The EXISTING Facility:
, Name System Installed Under: `.J 2 �(� Type Of Facility: . %�(�r�
Date System Installed(Month/Date/Year): /�'!�� nNumber'OfBedrooms: � Number OfPeople:�
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Is The Facility Currently Vacant? Yes ;� If Yes,For How Long? '
� Any.Known Problems? Yes � If Yes,Explain:
Please Fill In The Foll wing nform tion A ut The NEW Fa '1' � � � C Q�.,���i�i"1't�d�i� ��f"
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Type Of Facility: e��l(/lti�la�ti � �rk C�A �T"er Of Bedrooms: Number of People
�uested By: Date Requested: •
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, � For Environmental Health Office Use Only
Approved Disapproved �
Comments: /L' / l�' (/� �Z T �
Environmental Health Specialist Date: 2 ! �
*The signing of this form by the Environmental Health Staff is i no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site�vastewater system wi 1 function properly for any given period of time.
Payment: Cash Check Money Order # Amount:$ Date:
Paid By; Received By:
Account#: Invoice#:
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