HomeMy WebLinkAboutRBPR-05-2016-23912.TIF S1l'A • THIS IS NOT A PERMIT Case # RBPR-05-2016-23912
ra CATAWBA COUNTY HEALTH DEPARTMENT • Y ro•t• 0
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v " °� � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES dy:
1842 sM Residential Building Plan Review - Building New of •� ti G %
IMPROVEMENT- AUTH CONST- NEW WELL ; -• t.
Contractor *RMR CONSTRUCTION CO INC (RICHARD MATTHEWS), 119 CONOVER BLVD E, CONOVER
28613-
B:828-464-8597 C:8283I20743F:828-466-1576 RMR @RMRREALESTATE.COM
Owner CHARLES GANTT, 3342 STONESTHROW DR,NEWTON NC 28658-8883
H:8284645414 HOME:8284645414
NAME TO APPEAR ON PERMIT
Charles Gantt
SITE ADDRESS: 3981 NORTHERNMISTIC DR, MAIDEN NC 28650 PIN # 362703336437
NAME of SUBDIVISION: FLYING V ACRES Lot# 2 Section/Block
PROPERTY SIZE: Square Feet Acres 0.46
DIRECTIONS: Startown Rd, right Blackburn Bridge Rd, left on Herter Rd, left on�� N�� 136er nisN'e,-en-
PRIMARYCONTACT: Contractor SEWER SeoticTank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
DESCRIBE WORK: building single family dwelling 1829sf 3 bedrooms 2full bathrooms one story no basement attached garage
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
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS:
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 52 x 32
#OF NEW BEDROOMS:: 3
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
E9-ehappllcatlon 06/06/2016 10:11 Page 1 of 4
vag• \ CATAWBA COUNTY Case# RBPR-05-20 1 6-23 9 1 2
i i t&L Public Health Department Subdivision FLYING V ACRES
\"r ;nrcg; .4 Environmental Health Division PIN# 362703336437
\ z/ PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
NAME ON PERMIT: (CHARLES GANTT), 3342 STONESTHROW DR, NEWTON NC 28658-8883
( Charles Gantt)
Site Address: 3981 NORTHERNMISTIC DR, MAIDEN NC 28650
Property Size: Square Feet Acres 0.46
Directions: Startown Rd, right Blackburn Bridge Rd, left on Herter Rd, left on Northernmistic, 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 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
AREA2
F io 311 i l i mar: f Ii4t. I MMl
E ENAME> lil31i wI t1 i IM l, S IA 04:f DATE gh.*:i . FEEAOUNT
Authorization to Construct Fee (New/Expansion) 05/20/2016 $150.00
Fee
Improvement Permit Fee 05/20/2016 $150.00
Well Permit& Inspection Fee 05/20/2016 $300.00
I tlg 1II ;roTALFEE ff , 'ry;I ili rliu t VVI l0 Iu 111lluli fi h lii11 *I 60 01
00 .
it, -.h ii tultnl ll ti,;n,,..,.• ..,Qltl,girypluflW i.ta 9a. M -fi8J'WO inulauip . ir,. ,.,..6 i k- .9,'
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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