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HomeMy WebLinkAboutRBPR-03-2016-23441.TIF t'A THIS IS NOT A PERMIT Case # RBPR-03-2016-23441 4 t G2 CATAWBA COUNTY HEALTH DEPARTMENT la• . no Xf El• `.) lrdl"j PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti �y. 842 s� Residential Building Plan Review - Manufactured Home �o ;o _:a IMPROVEMENT a •0 rP .� • 'Al SE , - er rlia tArA Applicant *CLAYTON HOMES # 81 /CMH INC(UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 B:828-465-3450F:828-464-026 I JWHOLDERaHOTMAIL.COM /` ontact Person CLAYTON HOMES (BOBBI *LASAGE), PO BOX 132, TAYLORSVILLE NC 28681 C:8282173168 JWHOLDER@HOTMAIL.COM Contractor *CLAYTON HOMES # 81 /CMH INC (UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 B:828-465-3450F:828-464-0261 .1 W HOLD E R n HOTM A I L.COM Owner LIHU LITTLE, 7116 KLONDALE ST, SHERRILLS FORD NC 28673 C:8284832848 NAME TO APPEAR ON PERMIT Lihu Little SITE ADDRESS: 7116 KLONDALE ST, SHERRILLS FORD NC 28673 PIN # 460701055458 NAME of SUBDIVISION: GABRIELJ LITTLE Lot# Section/Block PROPERTY SIZE: Square Feet Acres 1.54 DIRECTIONS: Hwy 16N turn left onto E 150 HWY, turn left onto Mt. Pleasant RD, Right onto Little Mtn. RD, Turn left onto Klondale ST. #7116 PRIMARY CONTACT: Contact Person /) SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: 14x36 single wide w/6x6 front & back decks **Home must meet appearance criteria ---Screen or Remove Towing Tongue, Front Deck must be minimum of 36 sq ft, home must be masonry underpinned (can use vinyl if singlewide). Home must be parallel to road and must face front of property "If this new home is a replacement for an existing occupied home—that existing home must be removed from the site within 30 days of the issuance of the Certificate of Compliance** 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? Yes 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? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF 2 SW w/ roof over top EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 14x76 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 14x36, 6x6 front deck, 6x6 back deck #OF NEW BEDROOMS:: 1 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplicailnn 05/02/2016 08:53 Page I of 5 SSA • CATAWBA COUNTY Case# RBPR-0 3-20 1 6-2 3 441 .e' ti l. Public Health Department Subdivision GABRIEL J LITTLE 4r�q Environmental Health Division PIN# 460701055458 ib PO Box 389. 100-A Southwest Blvd.Newton,NC 28658 1g42 sw NAME ON PERMIT: (LIHU LITTLE), 7116 KLONDALE ST, SHERRILLS FORD NC 28673 ( Lihu Little) Site Address: 7116 KLONDALE ST, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1.54 Directions: Hwy 16N turn left onto E 150 HWY, turn left onto Mt. Pleasant RD, Right onto Little Mtn. RD, Turn left onto Klondale ST. #7116 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 AREA1 ************t*****************************************************************#***************************** ir — - -m53 " ?L07,. 577 tr Ej 9�{' m --- 1Ir�FFENAMEh tI ; ' DATj a,FEEAMOUNT o Improvement Permit Fee 03/21/2016 5150.00 h� ����lii�IlfIIj ;TOTALFE_ES " frog' k Fit ra£Miur��lliI ikillrt'r" re,.SI50oo i .La d:1i Nth ' idLlt�r — ALL, ,4hildi I:..fmiWHL.i: I r 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-ehapplieation 05/02/2016 08:53 Page 2 of 5 v,,,< A •G THIS IS NOT A PERMIT Case # RBPR-03-2016-23441 its , CATAWBA COUNTY HEALTH DEPARTMENT ' d *rat a IO .t. . t .+ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • Ig42 s* Residential Building Plan Review - Manufactured Home ro C• imogi } IMPROVEMENT F d Applicant *CLAYTON HOMES # 81 /CMH INC(UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 B:828-465-3450F:828-464-0261 JWHOLDER @HOTMAIL.COM Contractor *CLAYTON HOMES# 81 /CMH INC(UNLICENSED), 1230 CONOVER BLVD,CONOVER NC 286 B:828-465-3450F:828-464-0261 JWHOLDER @HOTMAIL.COM Owner LIHU LITTLE. 7116 KLONDALE ST. SHERRILLS FORD NC 28673 C:8284832848 NAME TO APPEAR ON PERMIT Lihu Little SITE ADDRESS: 7116 KLONDALE ST. SHERRILLS FORD NC 28673 PIN # 460701055458 NAME of SUBDIVISION: GABRIEL J LITTLE Lot# Section/Block PROPERTY SIZE: Square Feet Acres 1.54 DIRECTIONS: Hwy 16N turn left onto E 150 HWY, turn left onto Mt. Pleasant RD, Right onto Little Mtn. RD, Turn left onto Klondale ST. #7116 PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: . Private Well DESCRIBE WORK: 14x36 single wide w/6x6 front & back decks **Home must meet appearance criteria --Screen or Remove Towing Tongue, Front Deck must be minimum of 36 sq ft, home must be masonry underpinned (can use vinyl if singlewide). Home must be parallel to road and must face front of property **If this new home is a replacement for an existing occupied home—that existing home must be removed from the site within 30 days of the issuance of the Certificate of Compliance" 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? Yes 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? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF 2 SW w/ roof over top EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 14x76 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 14x36, 6x6 front deck, 6x6 back deck #OF NEW BEDROOMS:: 1 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplieation 03/21/2016 16.10 Page 1 of 5 .v,A CATAWBA COUNTY Case# RBPR-03-2016-23441 stilt Public Health Department Subdivision GABRIEL J LITTLE < 01{^C Environmental Health Division - PIN# 460701055458 PO Box 389, I00-A Southwest Blvd.Newton.NC 28658 1842 :. NAME ON PERMIT: (LIHU LITTLE), 7116 KLONDALE ST, SHERRILLS FORD NC 28673 ( Lihu Little) Site Address: 7116 KLONDALE ST, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1.54 Directions: Hwy 16N turn left onto E 150 HWY, turn left onto Mt. Pleasant RD, Right onto Little Mtn. RD, Turn left onto Klondale ST. #7116 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 labe ing of all property lines and corners and making the site acce e so that a co a lete sit- evalf ation can be performed. Date: 3/at 11 Signature ofApplicant orAgent riTht�y . �/ An environmental Health Specialist will contact you within 5 working days of atilication'eate. If you need further information or assistance please call 828-466-7291 AREA1 'FEENAME .: DATE FEE AMOUNT. ; Improvement Permit Fee 03/21/2016 $150.00 TOTAL •;:„ ' I , ' 5150.00.::i 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-ehapplication 03/21/2016 16:10 Page 2 of 5 r e O3 D.ell - a%4 / CATAWBA THIS IS NOT A PERMIT couxrti 12 w CATAWBA COUNTY HEALTH DEPARTMENT .,,,,ti;.,. Application for Environmental Services Page 1 Improvement Permit Authorization to Construct H Septic Repair ❑ Septic Malfunction 111 Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Requirredd) /l) ) Ill Application Iis for New Construction 111 Existing Facility v�\ Property Address J l I la K I,(tyyla,je 5T, Subdivision Shern MS 1% ad 1\1C- Lot# Acres 023167 3 Section/Block/Phase Driving Directions to Property RIASY I lip N 7 A,S le ft na 3 j (3 -170 Arl tef-I- b✓ MC p Iczasant gd ( on /J-If 1evyr!, /260 71)in in L.e-F-i" Lnte JK�Io✓ dccl e s1-. IC -71 o . NAME TO APPEAR ON PERMIT? OcJ Owner III Applicant ❑ Contractor Applicant Contact Information / ' Name /_ Att. aft./ C _ :mri /4/0 it SCe_ - Address I 2,),C) elicit_ 61 u LO Phone 8 28 . 217 -r3I to g Cell Phone @2g-21 7_ -?1 4,„S Owner Contact Information y Name Li I IA Lee L e Address ti f I l P k S o a r e r( /t i c Vint) pl'(c73 Phone 828-i-Ie3_28'4e Cell Phone Mb* Contractor Contact Information Name C !cC" b� Yhn n W2 4451 License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site,,,ifi(.f!%%g.e r •! •S * f TOP # of Bedrooms * Structure Dimensionsa �' ti-4 X `1(.v # of Occupants Basement ❑ Yes No Basement Fixtures ❑ Yes 114 No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the prope n question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes No Does the site contain any jurisdictional wetlands? Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes o Is any wastewater going to be generated on the site other than domestic sewage? ,,Yes "No Is the site subject to approval by any other public agency? ❑ Yes ( No Are there any easements or right of ways on this property? Describe Existing water supply in use K Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes o If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ny ATA 7 THIS IS NOT A PERMIT COUNTY V..V 17 BA CATAWBA COUNTY HEALTH DEPARTMENT (eb Application for Environmental Services Pag- cOX 10 Proposed Facility Type i,; `�^'- WPrimary Residence IL1, New Residence ❑ Addition to Residence # of New Bedrooms *t 1 Project Description MEN I4Y3l0 St 1ew,C11Rb StutCp 401,0— Structure Dimensions t1 k3L # of Occupants Basement ❑ Yes [ ] No Basement Fixtures ❑ Yes Zi No n Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing ❑ Yes n No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j Total # Bedrooms *j Structure Dimensions- ❑ Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) Fl Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts n Other Facility Type Specify If Church# of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored ❑ Dug n Unknown Well Repair Requested ❑ Yes n No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. f If structure is plumbed but no bedrooms, calculated design flow is required. ** If No,a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 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.Signature of Owner or Agent r ijSt 1 £ LCaA; Date /2_1 / 1/ • Printed Name of Owner or Agent Jtit ca � L /ILL _ III/. /414-6( Catawba County Environmental Health 10.9 �a2 Al . a 1 ■ E •s.0° 7 • • ti� �p2 15 •S 40 ` ,'impe s,.> ss )11001. w ti cp CJS /" a` ;�G� si91.93 4$141 `\y 4. r t s 5.0 G N. a.O ik` 0 .s5 Icy, tP Parcel: 460701055458, 7116 KLONDALE ST 1 in=60ft SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/21/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460701055458 Owner: LITTLE LIHU LEE Parcel Address: 7116 KLONDALE ST Owner2: City: SHERRILLS FORD, 28673 Address: 7116 KLONDALE ST LRK(REID): 11419 Address2: Deed Book/Page: 2055/1005 City: SHERRILLS FORD Subdivision: GABRIEL J LITTLE State/Zip: NC 28673-9729 Lots/Block: / School Information: Last Sale: Plat Book/Page: 18/96 School District: COUNTY Legal: RD 2649 PL 18-96 PL 18-96 Elementary School: SHERRILLS FORD Calculated Acreage: 1.540 Middle School: MILL CREEK Tax Map: 011 X 03009 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 2649 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $7,500 Zoning2: Land Value: $21,300 Zoning3: Assessed Total Value: $28,800 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460700J Building Details 2010 Census Block: 3028 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P31 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. ') Ia\01\Qr\I\ leatt cywyk■ Th mrl .kern 010 9Q) ) fd h h be'lbaj A http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460701055458&typ=P 3/21/2016