192 Hobson Drive Lots 5-8Davie County, NC Tax Parcel Report Tuesday, January 31, 2017
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WAK ING: THIS 1S INUIL' A bUKVEY
Parcel Information
M5060B0008 Township: Jerusalem
5745585837 Municipality:
82519613 Census Tract: 37059-807
VERGASON MICHAEL T Voting Precinct: COOLEEMEE
192 HOBSON DRIVE Planning Jurisdiction: Davie County
MOCKSVILLE
Land Value:
Total Assessed Value:
040]
27028-0000
LOTS 5-8 HOLIDAY ACRES SECTION 1
0.34
10/2002
004420801
0003
108
Zoning Class: DAVIE COUNTY R-20
Zoning Overlay: DAVIE COUNTY CZOD
Voluntary Ag. District:
No
Fire Response District:
JERUSALEM
Elementary School Zone:
COOLEEMEE
Middle School Zone:
SOUTH DAVIE
Soil Types:
GnB2
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
All data is provided as Is without warranty or guarantee of any Idnd 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
NCCounty of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
Fa7
or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
ATC Number: 5944
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems,"
but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of
time.
System Type: S.T. Manufacturer Tank Date Tank Size
Pump Tank Size Bedrooms
System Installed By: Installer#: Date:
GPS Coordinate:
Environmental Health Specialist:
DCHD 11/06 (Revised)
Date:
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Account #:
990005893
Tax PIN: EH #:
M5060B0O08
Bilied To:
Bonnie Vergason
Subdivision Info:
Holiday Acres Lot # 5 - 8
Reference Nance:
REPAIR PERMIT
Locatibn/Addrbss:
:192 Hobson Drive -27028
Proposed Facility:
Residential Repair
Property Size:-
0.34 Acres
ATC Number: 5944
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems,"
but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of
time.
System Type: S.T. Manufacturer Tank Date Tank Size
Pump Tank Size Bedrooms
System Installed By: Installer#: Date:
GPS Coordinate:
Environmental Health Specialist:
DCHD 11/06 (Revised)
Date:
**NhQ T ** Thi � horization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
p�T e"a1RS cfion i`i to.issuance of any building per'mi it(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use chan1le.
Residential Specifications: # Bedrooms 3 # Bathrooms 4 People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size .3 a_ Type of Water Supply: QCounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) '3(CO_Tank Size AL. Pump Tank / GAL.
Trench Width Max. Trench Depth_ Rock Depth— Linear Ft. y�� �s�`h
Site Modifications/Conditions/Other: oil
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
eXIS ,J tt� LW' w
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0
Environmental Health Specialist KJO40QUDate: 97
DCHD 11/06 (Revised)
4
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990005893
Tax PINIEH #:
M5060B0008
Billed To:
Bonnie Vergason
Subdivision Into:
Holiday Acres Lot # 5 - 8
Reference Name:
REPAIR PERMIT
LocationiAddress:
192 Hobson Drive -27028
Proposed Facility:
Residential Repair
Propeie:
❑�1S,NAair ❑Expansion
**NhQ T ** Thi � horization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
p�T e"a1RS cfion i`i to.issuance of any building per'mi it(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use chan1le.
Residential Specifications: # Bedrooms 3 # Bathrooms 4 People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size .3 a_ Type of Water Supply: QCounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) '3(CO_Tank Size AL. Pump Tank / GAL.
Trench Width Max. Trench Depth_ Rock Depth— Linear Ft. y�� �s�`h
Site Modifications/Conditions/Other: oil
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
eXIS ,J tt� LW' w
C
0
Environmental Health Specialist KJO40QUDate: 97
DCHD 11/06 (Revised)
4
S
1
ti
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
Davie County Health Department D
Environmental Health Section
P. O. Box 848
Mocksville, NC 27028
(336)751-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEdLiNL
ALL THE REQUIRED INFORMATION IS PROVIDED.
Name to be Billed P / L,, f�/� �� Contact Person _
MAR 2 a isse
Mailing Address % //d S'O� �/ , Home Phone :25951-2261
City/State/Zip O(` i f iw ille Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For:
4. System to Serve:
5. If Residence:
❑ Dishwasher
❑ Site Evaluation
❑ House Mobile Home
# People Ll
City/State/Zip 01
❑ Improvement Permit & ATC l/Both
❑ Business ❑ Industry
# Bedrooms �2 O .3
❑ Other
12 # Bathrooms_
❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other: Specify type
# Commodes
If Foodservice:
7. Type of water supply
# Showers
# Seats
County/City
# Urinals
# People . # Sinks
# Water Coolers
Estimated Water Usage (gallons per day)
❑ Well
8. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Community
❑ Yes ❑ No
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAW)BWXHE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions:_WRITE DIRECTIONS (from
pr�l C - d 1 Mocksville) TO PROPERTY:
Tax Office PIN:%'�� -� - �& 1 6
('J /
1 l 5 to
Property Address: Road Name cy /` 1 /
OA figoAna.,
City/ZipaC 4✓i�� o�%�� 1
1
If in Subdivision provide information, as follows: 1
I OA le fZ
Name: - C e 1
1
Section: Lot #:� � /2. /'3 A
�� .-, .4 I& -I^ 1
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter
are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is
falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to
the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County
ryand owned by 7pL/— to conduct all testing procedures
as necessary to determine the site suitability.
DATE 2 -;2y " &7 T SIGNATURE
Revised DCHD (06-96)
YOU MAY USE THE $LICK Of THIS FORM FOR DRAWINC7 YOUR SITE PLAN.
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5745-51r 0726 �L 504796
5745- -0655 4 �-1
5515
IS 5745-56-0566 '
5525
5745-56-0487 0
Z 5445
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5745-56-1306
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5745-56-1226
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5745-56-1147
6104
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6023
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5745-55-2728 67
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(10 05A)
5745155-3145
INDEXEDIDN 5745.