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Home My WebLink AboutEHPR-12-09-3088 (2).TIF A C THIS IS NOT A PERMIT Case # EHPR-12-09-3088 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services I84ti SM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER CONTRACTOR DONNIE FULBRIGHT DONNIEFULBKIGHI" 5927 STARTOWN RD 5927 STARTOWN RD NEWTON NC 28658 NEWTON NC 28658 NAME TO APPEAR ON PERMIT DONNIE FULBRIGHT Pin#: 362812776391 SITE ADDRESS: STARTOWN RD, Newton, NC DIRECTIONS: HWY 10 W, LEFT ON STARTOWN RD, 1/4 MILE ON RIGHT PAST COULTERS AME ZION CHURCH NAME of SUBDIVISION: DONNIE & KATHY FULBRIGHT Lot # 3 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.004 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 80 X 30 Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes 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 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: NO Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? NO 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. c ` Date: - /0 - r / Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application ate. If you need further information or assistance please call 828-466-7291 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Improvement Permit Fee 12/10/2009 5150.00"""~ Rear 30 TOTAL FEES $150.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/10/09 14:01 CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Thursday, December 10, 2009 1$ 42 sM www.catawbacountync.gov Plan Case: EHPR-12-09-3088 Invoice Number: INV-12-09-257931 Environmental Health Plan Review Invoice Date: 12/10/2009 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 12/10/2009 Check 3646 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 pin ivceipt ;69n7 )56-06 1-4978-980)-.i'10481 173x7; ipt 12/10/2009 14:01 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit N Authorization to Construct ❑ Septic Repair El Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit V e-'V'6e1x= 11-5 % 2. Permit Requested By v,cJ ; e Lc) ILCMP'ill-T Business Phone Address -~3 2 7 575E,.ry,_.j.v Home Phone ~ ~-~,2C- ?-/So 3. Property Owner Vii} .,ti -F Business Phone me 3 ~1, S 13 ~ Address Home Phone 4. Name of Subdivision Lot # 3 Section/Block/Phase Property Address Directions to Property: 5. Property Size: Square Feet / Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure gCV3 b Bedrooms* *Any room that-will be intended for sleeping at the tune of constriction or.'for.fut ire 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 pe " issuance. This; may prevent,the need for system siz crease in the future. Basement• ye)/no Water Using Fixtures in Basement: yes no No. in Family Whirlpool W b yes/no 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 1 st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes /QNIq/ 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? Ye No 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [i 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 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 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 - /L> - 0 9 Signature of Owner or Agent i f< 4