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117 Rose Arbor LnDavie County. NC Tax Parcel Report Thursday, October 6, 2016 Shady Grove 37059-804 WEST SHADY GROVE Davie County DAVIE COUNTY R-20 CORNATZER - DULIN CORNATZER WILLIAM ELLIS Gn132 DAVIE COUNTY 81340.00 Total Assessed Value: 81340.00 No 0.00 �v All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the 9"' F 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 r'pUN�'4 NC or arising out of the use or Inability to use the GIS data provided by this website. WARMIN T: TH1J 1S 1VU1' A SURVEY Parcel Information Parcel Number: 160000007511 Township: NCPIN Number: 5758636632 Municipality: Account Number: 82517272 Census Tract: Listed Owner 1: OWENS BARRY M Voting Precinct: Mailing Address 1: 174 ROSE ARBOR LANE Planning Jurisdiction: City: MOCKSVILLE Zoning Class: State: NC Zoning Overlay: Zip Code: 27028-7459 Voluntary Ag. District: Legal Description: 1.000 AC CORNATZER RD Fire Response District: Assessed Acreage: 0.87 Elementary School Zone: Deed Date: 12/2014 Middle School Zone: Deed Book / Page: 009760497 Soil Types: Plat Book: Flood Zone: Plat Page: Watershed Overlay: Building Value: 54510.00 Outbuilding & Extra Freatures Value: Land Value: 26830.00 Total Market Value: Shady Grove 37059-804 WEST SHADY GROVE Davie County DAVIE COUNTY R-20 CORNATZER - DULIN CORNATZER WILLIAM ELLIS Gn132 DAVIE COUNTY 81340.00 Total Assessed Value: 81340.00 No 0.00 �v All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the 9"' F 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 r'pUN�'4 NC or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department 836 Environmental Health Section ., . P.O. Box 848 I�210 Hospital Street ' U Courier # : 09-40-06 i 1 Mocksville, NC 27028 f� Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: f3Q- ar' 0- OU..I Q.✓15 Phone Number 3 RL- q q'$ r (7 9 11 (Home) Mailing Address: 1 71 q ::T:�QS P Ay k y' L4 GL44VA (Work) Ma c l 5 (7 iP - Nf� _�-_ Email Address: VA m C2 U 0 ej , ri Please Fill In The Following Information �� About The EXISTING Facility: �[ Name System Installed Under: �6-,u JoY6WSQ l�% Type Of Facility: Date System Installed (Month)Date/Year): -/1 q -Yl Number Of Bedrooms: -S - Number Of People: Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: 2 �, w�'1'(rd 6P Number Of Bedrooms:_t6=9umber of People Pool Size: Gagq Size: Other: Requested By: (Signature) Approved Disapproved Requested: 1 - X7 -16 For Environmental Health Office Use Only . c!7 Environmental Health Specialist Date: / "A 7 *The 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: Cash Check Money Order # Amount:$ Date: Paid By: Received By: Account #: Invoice #: �� i f1