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Home My WebLink AboutEHPR-11-09-2572.TIF 'A C THIS IS NOT A PERMIT Case # EHPR-11-09-2572 CATAWBA COUNTY HEALTH DEPARTMENT U ®a®. Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP APPLICANT' OWNER_ C ONTRACTOR RALPH-CLINE RALPI-I CLINE 223I'MT.'OLIVE CI IURCH RD Q 2231 MT. OLIVE CHURCH RD Q , NEWTON NC 28658 NEWTON , NC 2865'8' 828-461-0450 828-461-0450 NAME TO APPEAR ON PERMIT RALPH CLINE Pin#: 375013120999 SITE ADDRESS: MT OLIVE CHURCH RD, Newton, NC DIRECTIONS: HWY 10 E - TURN RIGHT ONTO MT. OLIVE CHURCH RD - PROPERTY ON RIGHT NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Squarel eet Acres .620 Date Platted/Recorded T TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 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: NO Has any grading, removal, or addition of soil been done;to,,this propertyz-, If so, describe NO Are there easements/right-of-ways recorded on this property" NO - Type of Water Supply: Individual Well _ Community Well Municipal X 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: 6 - v, Signature of Applicant or Agent ~ An Environmental Health Specialist will contact you within 2 w rking days of application date. If you need further information or assistance please call 828-466-7291 AREA1 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side hiiolotc1ti-'IIt Permit'Fee', ~1 1/106/2009 $1j-0. UU Rear 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 11 /06/09 16:31 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT A lication for Environmental Services Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New)Well Permit ❑ Replacement Well ❑ Well Abandonment E] 1. Name to Appear on Permit j~ cc ( 17 1 F, C / ( I H w 2. Permit Requested By C Business Phone a 3' -lo -.6U-S6 Address JqL1 I _L134. C. ' ,-e- t e W ot Home Phone ~~d: F- V 6 Y- 6 3 2 6 3. Property Owner _ Business Phon 11-6 q J-6, Address t Home Phone 4. Name of Subdivision eA uner C Lot # ;;2, Section/Block/Phase Property Address 2 3 ,0 e w CJ! C K Directions to Properly: w a `'aG CGS K A ko Gtr E G ~n y" I 5. Property Size: Square Feet Acres 02 O Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure .30X~_Fo Bedrooms*_ 7T *Any room di,u % ill be'intended for sleepin'- at the time of'Comtru'ctioi1 ~n 10l [Utur~ ~It o[i mild be n(,I~,d ;I< <1 bedroom and counted oil all applications. The numbe1 ',-d' loc lioon~s Will he <<~iifI T] :d h I )iln ~ I, 1"I titled on hoij ~ ai, as,,a bedroomat the time of buildin permit issuance this u1111 Preventthe n I~, sizes in the tutors. Basement yes no Water Using Fixtures in Basement ye no No. in Family Whirlpool Tub 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? Ye / No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Ye / No If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes N 10. Is a public water supply available on or adjacent to the above property? Yes / N 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: [ ] 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 TH R PERTY, THERE IS N ADDITIONAL CHARGE." Date U 7 Signature of Owner or Agent C olt~__ A CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT ~ Newton, NC 28658- (828)465-8399 FridaYf November 6f 2009 184 Z sM www.catawbacountync.gov ~ Plan Case: EHPR-11-09-2572 Invoice Number: INV-11-09-257079 Environmental Health Plan Review Invoice Date: 11/06/2009 Fee Name Fee Amount -7 7 Improvement Pemiit Fue -Fixed ;150.00,' Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid. Change 11/06/2009 Credit Card -1 $150.00 $0.00~~ Total Paid: $150.00 Total Due: $0.00 planreceipt;01d~96ea-c1~=1-~(ilti-9t3ti- Q.h)~9{;d221;.rpt 11/06/2009 16:28