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Home My WebLink Aboutimage0001.tif ys$A THIS IS NOT A PERMIT Case # EHPR-10-09-2398 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services IS 43, sm Environmental Health Plan Review - OSWP APPLICANT' JUSTINA D ROBBINS JUSTINA D ROBBINS 2436BAY LEIGH DR 2436BAY LEIGH DR VALE NC 28168 VALE NC 28168 828-302-3515 828-302-3515 NAME TO APPEAR ON PERMIT JUSTINA D ROBBINS Pir*: 266801399023 SITE ADDRESS: 2436 BAYLEIGH DR, Vale, NC DIRECTIONS: TAKE I-40 WEST TO EXIT 121/ OLD SHELBY RD/ RT GO 6-7 MILES TOJACOB FORK RIVER RD/ RT 1 MILE TO ELLEN'S WAY OR BAYLEIGH DR ON RT/ I ST HOUSE ON RT NAME of SUBDIVISION: ELLENS WAY Lot # 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 3 Basement: No Water Using Fixtures in Basement: No. in Family 3 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees I st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: ADDED ROOF TO EXISTING SIDE PORCH AND ADDED 14'X 28' TO MAKE IT LARGER ALSO THERE ARE ACCESS STRUCTURES ON Has any grading,ail'lEtA dtrCo7t If so, describe Are there easements/right-of-ways recorded on this property? 0 Type of Water Supply: Individual Well X Community Well Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME ATE AMOUNT Side Existing Tank Check Fee I10/28/2009 $80,00 Rear TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 10/28/09 16:53 THIS IS NOT A PERMIT Val" .(q PR -1 0 '09 -L3 Sd +ATAWBA COUNTY HEALTH DEPARTMENT Ap cation for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Pe it JVS J' r\ (Z®bh c nS 2. Permit Requested By r1V Business Phone ,2a5 - 4S(aa~ Address ~tc'j P_ C. Home Phone 30,x^ 2- If 5 3. Property Owner Business Phone Address Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directions to Property: To- rho- _T 40 ( ye-.5 4-0 LA Jo o l S I `f! 2~ ro fZ X51. or S w 4 k Gr 0 IQ-- S c.ce r 5. Property Size: Square F et _300 Acres Date Platted/Recorded O 6. TYPE OF FACILITY: House Mobile Home _ Dimension of Structure Bedrooms* 73 ~Jd *Any room thkwill be intended for,sIeepipgeat the tiine,of construction or for future conside a 'ors shout ~d as a C , bedroom ant;Iteounted on`a11 applicatinS number'of bedrooms will be confirmed by roasderttifcd o pl Jri' l'' ' 3.~permit ssuance. This ;may prevent the need for system size 1ncrease,in the;;fuftxre. bedroom at,the time ofbvuildmg.. Basement: ye Water Using Fixtures in Basement: yes/~ No. in Family 7 Whirlpool Tub yes4i Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / o 0 If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / o If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / o 10. Is a public water supply available on or adjacent to the above proper Yes o Check type that is available: [ ] Community well [ ] Semi-public well [ ounty/City/Township water line 0 **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well I understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on (A) this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a 'T_ result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.- Date Signature of Owner or Agent I~G In•n (_Yd}r'4R^Aerr 4~1 k • 1 Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba Countypromotes and recommends the independent verification of arty data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 2668-01-39-9023 1 inch = 60 feet Prepared for: t 1 1 j ~T J I it R- Q •4 1 r s. 1A0 510 . . f THIS IS NOT A LEGAL DOCUMENT Wednesday, October 28, 2009 01:16 PM