HomeMy WebLinkAboutRBPR-04-2015-21367.TIF n CATAWBA COUNTY
IOOA SOUTHWEST BLVD RECEIPT
NEWTON, NORTH CAROLINA 28658
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PHONE: 828.465.8399
U l , �C Wednesday, May 11, 2016
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PAY OR:
Hamby, Michael&Cheryl
PAYMENTS
TRANSACTION NUMBER: TRC-670624-11-05-2016
PAYMENT DATE : 05/11/2016
PAYMENT TYPE: Credit Card
payment by phone from Cheryl
INVOICE NUMBER FEE NAME FEE AMOUNT
05-16-328219 Re-Trip or Redesign Fee $70.00
05:='116='328219ll Q'�jf � nc;;s . cdi in ReT[iFa Retlesigri;Fee'�� 1r,, lill MOWN $7000
TOTAL PAYMENTS : $140.00
RBPR-04-2015-21367
CASE TYPE: Residential Building Plan Review WORK CLASS: Building New
SITE ADDRESS: 9391 LEGRAND DR, TERRELL NC 28682
Owner MICHAEL& CHERYL HAMBY, 3654 BROOKS LN, TERRELL NC 28682
H:7042418385C:7044506053
** NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 05/11/2016 10:24 Page I oft
.hY A -"-•C.- THIS IS NOT A PERMIT Case # RBPR-04-2015-21367
iv.Qr CATAWBA COUNTY HEALTH DEPARTMENT U r �o i0
�4pg" N PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES {: v % t
1842 sM Residential Building Plan Review - Building New {o ro r:
IMPROVEMENT - A TH CONST - NEW WELL ? . - ,:bLcdr4)1 , La - 2 C HiThil S (Z)
Owner MICHAEL&CHERYL HAMBY, 3654 BROOKS LN, TERRELL NC 28682
H:70424I8385 C:7044506053 HOME:7042418385
NAME TO APPEAR ON PERMIT
Michael & Cheryl Hamby
SITE ADDRESS: 9391 LEGRAND DR, TERRELL NC 28682 PIN # 462701268855
NAME of SUBDIVISION: Lot# 3B Section/Block
PROPERTY SIZE: Square Feet Acres 0.69
DIRECTIONS: 9391 LEGRAND DR, TERRELL
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY 480 WATER SUPPLY: Private Well
DESCRIBE WORE< Revised 5/11/16 -Added 2 Re-Trips ($70 each). Re-trips on 3/17/16 &4/13/16 by RP.-)
new single family dwelling 50 x 98/ no basement/copy of recorded plat on file
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES", then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? No
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF VACANT LOT
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 50 X 98
#OF NEW BEDROOMS:: 4
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES
OTHER: INNOVATIVE: ANY:
Other described:
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
H9-ehappl[cation 05/11/2016 10:33 Page I of 4
SsA CATAWBA COUNTY Case# RBPR-04-2015-21367
¢=�� � Public Health Department Subdivision
�I°ipptt ,, Environmental Health Division PIN# 462701268855
'�`I- PO Box 389. 100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: (MICHAEL&CHERYL HAMBY), 3654 BROOKS LN,TERRELL NC 28682
( Michael & Cheryl Hamby)
Site Address: 9391 LEGRAND DR, TERRELL NC 28682
Property Size: Square Feet Acres 0.69
Directions: 9391 LEGRAND DR, TERRELL
Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An
Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable: Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application,site plans or intended use changes for the proposed facility.
I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted
right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the
proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 5 working days of application date.
If you need further information or assistance please call 828-466-7291
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FIIC'E'NIPIiI1umfi ll�rlllia ,y it 1 11}1lI �. t I'i j iI1jilll If tl ll 11p9h1 n I: ,t, rll r pl iNY�t{�i}{ryr
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Authorization to Construct Fee (New/Expansion) 04/24/2015 $300.00
Fee
Improvement Permit Fee 04/24/2015 $150.00
Well Permit& Inspection Fee 04/24/2015 $300.00
Re-Trip or Redesign Fee 05/11/2016 $70.00
Re-Trip or Redesign Fee 05/11/2016 $70.00
ss9o�o 114II IPTOTAL FE 1 Y IIVI11101Pl'l 41(II Illliilll 1 ' lii li 111 1III11n . i1
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FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
E9-chappla:me n 05/11/2016 10:33 Page 2 of 4