HomeMy WebLinkAboutEHPR-02-2016-23199.TIF Y,A �G THIS IS NOT A PERMIT Case # EHPR-02-2016-23199
CATAWBA COUNTY HEALTH DEPARTMENT D 04� U
��)�"° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 9t �'
1842 sM Environmental Health Plan Review - OSWP "c o �. su
IMPROVEMENT ay
Owner ROBERT LAKE, 4682 S OLIVERS CROSS RD, MAIDEN NC
C:7708651184
NAME TO APPEAR ON PERMIT
ROBERT LAKE
SITE ADDRESS: 4506 S OLIVERS CROSS RD, MAIDEN NC 28650 PIN # 367601391324
NAME of SUBDIVISION: Lot# Section/Block
PROPERTY SIZE: Square Feet 128,066.40 Acres 2.94
DIRECTIONS: S Hwy 16, Right Buffalo Shoals Rd, Left S Oliver Rd, about 3/4 mile on Left.
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
,IALLONS PER DAY: 480 M WATER SUPPLY: Private Well
DESCRIBE WORreevise• • • - . •-. . • s.` - s -480 GPD
IP Only*
House 46x49, Detached garage 24x32, Future Shop 60x60 w/ no plumbing.
Public Water is available. House will be 395 feet from road. Wants a location marked for well.
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? No
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: House OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: House 46x49, Det. Garage 24x32, Fut Shop 60x60
DOF NEW BEDROOMS:: 4 )
ASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
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•
• CATAWBA COUNTY Case# EHPR-02-2016-23199
rcr i ,2, Public Health Department Subdivision
G .,e, Environmental Health Division PIN# 367601391324
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: ( ROBERT LAKE),4682 S OLIVERS CROSS RD, MAIDEN NC
( ROBERT LAKE)
Site Address: 4506 S OLIVERS CROSS RD, MAIDEN NC 28650
Property Size: Square Feet 128,066.40 Acres 2.94
Directions: S Hwy 16, Right Buffalo Shoals Rd, Left S Oliver Rd, about 3/4 mile on Left.
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 acc'- that a complete site evaluation can be performed.
Date: S— in — i1_, 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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Improvement Permit Fee 02/12/2016 $150.00
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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)
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