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Home My WebLink AboutEHPR-11-09-2755.TIF A Cpl THIS IS NOT A PERMIT Case # EHPR-11-09-2755 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services Ig42 SM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER CONTRACTOR MATTNEY A BURGIN MATTNEY A BURGIN 567 LUTHER DR 567 LUTHER DR IRON STATION NC 28080-6768 IRON STATION NC 28080-6768 (704)361-4713 (704)361-4713 NAME TO APPEAR ON PERMIT MATTNEY A BURGIN Pin#: 460601175291 SITE ADDRESS: 4641 GOLD FINCH DR DR, DENVER, NC DIRECTIONS: HWY 16 S, LEFT ON CAMPGROUND RD, I MILE TURN LEFT ONTO CATAWBA BURRIS RD, NAME of SUBDIVISION: PEBBLE BAY PH 3 REVISION Lot # 124 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.5 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure QXq c) Bedrooms 4 Basement: No Water Using Fixtures in Basement:No No. in Family 2 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 Ist 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 Community Well X 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 shoul confo to applicable setbacks. Date: /7709-Signature of Applicant or Agent An nvironmental Health Specialist will contact you within 2 wo ing days application date. If you need further information or assistance please call 828-466-7291 AREA 1 (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 11/17/2009 $150.00 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 $60 charge 11/17/09 14:26 THIS IS NOT A PERMIT WLS# • CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services IP AC S.T. Rpr. f- S.T. Exp. r Exist. S. T. F Well Permit F- Replacement Well 1. Name to Appear on Permit: HA VIN bUrllln 2. Permit Requested By: M~fy 6ur9in Business Phone: 104-3wqw Address: 5C¢l Lut-htr o rive, Iron Stafiion, NC AW60 Home Phone: X04 - 3lr 1- 03 3. Property Owner: P'levi-eq And A1116D►n e, ur61rl Business Phone: j0q ~q~13 Address: Lu+hcr Drive) Iron s~-ation) NC gtwoo Home Phone: 7D~ r q 4. Name of Subdivision: FNbl b ~ BaM Lot 12`~ Section/Block/Phase: P 3 Property Address: (p C(t~ Directions to Property: 0wy I& ~5. Turn 1c-1-on Ca.►,p,ground Q. Approx. I rrir14 Turn IiK-I- onto CafaWloa Oum's RoI.,QPprax. 3 proles turn rfoytb Dr%13anichW Cd, Turn W4 orri+o &oW Finck pyre. Lok Ia4 ovi +ht, riglrt coymr o-F GolA Fnah 0 OtM4 oac4 4094 Ortfc- ~og 5. Property Size: Square Feet a$~Iq Acres Date Platted/Recorded 6. TYPE OF FACILITY: V House C' Mobile Home Dimension of Structure Bedrooms*~ 'Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroc 'n and counted on all " applications. The number of bedrooms will be confirmed by rooms identified on the house plans as a bedroom at the time of building permit issuance. This may prevent the need for system size increase in the future. Basement: t` Yes k No Water Using Fixtures in Basement: C Yes N No No. in Family: a Whirlpool Tub: Yes t\- No Gallon Capacity: nla MULTIPLE FAMILY RE-1•'DENCES: Units F n(Q- Total Number of Bedrooms F~ DAY CARE: Number of Children F n IGv RESTAURANT: Seats I r11a Square Feet Dining Area nja. Square Feet Food Stand/Meat Market f ioor Space TYPE OF BUSINESS: ( n ~a No. of Employees 1 st F rt(ti- 2ndF ri I r:-3rd 57-IeZ OTHER : (Specify) F n I di," 40 Do you anticipate a, y additions to Facility? (-Yes #No If so describe 3D 371 i~ 8. Has any,grading, removal, or addition of soil been done to this property? Yes 0 No If so describe i Are there easements/right-of-ways recorded on this property? f- Yes 0 No 10. Is a public water supply available 'nor adjacent to the above property? Yes (-No Check type that is available: r Community Well F Semi-public Well r County/City/Township waterline 11. Well Type Applying For: F Individual Well F_ F_ Semi-public Well li Irrigation Well F Geot;?o I Well 12. Monitoring Well Request: C` Yes # of Wells: r of Site: I understand that this 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 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 set backs. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE Date: Signature of Owner or Agent: • Print Form • i Real Estate Search i ' i 1 ')G -1 r r r i rte' 420,4 - ~p_ I 1 33.01 Y~ r 5291 trt J J{ l 11 'y r ~ t 1 E C~ T 1 rt 1 i t5f i } ? HOS t f i } } 6022 'E Parcel Summary j Printed map scale 1 inch 90ft {I Parcel ID: 460601175291. Parcei Address: 7165 BAY RIDGE DR, DENVER I~ I[- Owner: BURGIN i~tATTN- A I Address: 567 LUTHER DR i City: IRON STATION i Owner2: BURGIN ALLISON A( Address2: j( State/Zip: NC, 28080-676811 1 -7- Building(s) Value: Land `Jame: $52,300 11 Total Value: $52,300 DISCLAIMER: This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has rnade 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 Count~j of I1 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. (I http://www.gis.catawba.nc.us/website/Parcel/printMap.asp?pinc=460601175291&paddr=7165... 1 i/i 1/2009 Catawba County, North Carolina This map product was preparedfrom the Catawba County, jVC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not he held liable for any and all damages, loss or liability, whether direct, indirect m- consequential which arises at- may arise from this map product or the use thereof by am, person or entity. Legend Selected Parcel Number: 4606-01-17-5291 1 inch = 60 feet Prepared for: r l I 17 . 23/4.17 _6. _-5 60 y t f s a v r fat 62`-~¢03f , x r Ildf r.50A r~ _ (Y d rv - 351.12 , 00 f Q - o i • TL~ cj-; THIS IS NOT A LEGAL DOCUMENT Tuesday, November 17, 2009 02:21 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 4606-01-17-5291 Name: BURGIN MATTNEY A Name2: BURGIN ALLISON A Address: 567 LUTHER DR Address2: City: IRON STATION State: NC Zip: 28080-6768 Account: 159754716 Calc Acreage: 1.5 Tax Map: LRK: 802817 Deed Book: 2982 Deed Page: 1729 Subdivision Name: PEBBLE BAY PH 3 REVISION Subdivision Block: Lots: 124 Plat Book: 62 Plat Page: 103 Building Number: 7165 Street Name: BAY RIDGE DR Site Zip: 28037 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: Land Value: $52,300 Total Value: $52,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 131 Watershed: WS-IV Critical Area Watershed Split: Voter Precinct: P41 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 4013 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Tuesday, November 17, 2009 02:21 PM CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT ] Newton, NC 28658- (828)465-8399 Tuesday, November 17, 2009 j84'Z sM www.catawbacountync.gov Plan Case: EHPR-11-09-2755 Invoice Number: INV-11-09-257322 Environmental Health Plan Review Invoice Date: 11/17/2009 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/17/2009 Check 1032 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 ~;I;n receipt ;t,'<<13r~~-1cJ~~-4~Kfi-hCi~ if fib=kle172, rpi 11/17/2009 14:23