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Home My WebLink AboutEHPR-2-10-3892.TIF A THIS IS NOT A PERMIT Case # EHPR-2-10-3892 CATAWBA COUNTY HEALTH DEPARTMENT v ^C Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - Repair REPAIR APPLICANT OWNER CONTRACTOR RONALD FULBRIGHT RONALD FULBRIGHT 6092 SMITH RD 6092 SMITH RD NC NC 704-462-1974 704-462-1974 NAME TO APPEAR ON PERMIT RONALD FULBRIGHT Pin#: 268702952540 SITE ADDRESS: 6092 SMITH RD, Vale, NC DIRECTIONS: GO PAST PROPST CROSS ROADS ON HWY 10 W TURN LEFT ON SMITH RD. JUST PAST BANOAK FOOD CENTER. IT WILL BE 8TH HOUSE ON LEFT. NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.17 Date Platted/Recorded TYPE OF FACILITY: I-louse Mobile Home Dimension of Structure 28X0 Bedrooms 3 Basement: NO Water Using Fixtures in Basement:NO No. in Family 2 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 0.00 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: 14X14 SUNROOM Has any grading, removal, or addition of soil been done to this property? If so, describe NONE 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. Date: 16 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need flirther 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 80 FEE NAME DATE AMOUNT Side 15 Authorization to Construct (Repair) F,02/16/2010 $300.00 Rear 30 TOTAL FEES $300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 02/16/10 1 1:3 8 THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit El Authorization to Construct ❑ Septic Repair El Septic Expansion El Existing Tank Check E] ew Well Permit F_1 Replacement Well ❑ Well Abandonment ❑ I. Name to Appear on Permit 2. Permit Requested By Business Phone `70 y- L11,2 1 V a l Address Home Phone ~ ,9y - h)b 3. Property Owner 2'a- 44a~4~ Business Phone Address - Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directions to Property: 5. Property Size: Square Feet Acres, d 17 Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure 2 ~4 5L~ Bedrooms* 3 *An_y room-;that will be intended forTslee]~in~ ,i~ the tirrie of construction or lo re consideration should be rioted as.a bedroom and counted on all apptications': 1 hc number of bedrooms will be c nitre ed by rooms_ide- ified.on house plans as a bcdrgom at the. time of building permit issuance: fhis,may prevent tt e need for system size incr6se.in'the-uture. Basement. yes ono Water Using Fixtures in Basement: yeo No. in Family 3- 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? Yes)/ No If so, describe: x 8. Has any grading, removal, or addition of soil been done to this property? Yes (3N 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 QNo 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 T`O,THEPROPERTY, THERE IS AN ADDITIONAL CHARGE.** Date" j Signature of Owner or Agent ! 5S'l s CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2687-02-95-2540 Name: FULBRIGHT RONALD LEE Name2: FULBRIGHT MARTHA JO Address: 6092 SMITH RD Address2: City: VALE State: NC Zip: 28168-9564 Account: 22942600 Calc Acreage: 2.17 Tax Map: 013 B 02011 LRK: 13678 Deed Book: 1032 Deed Page: 0950 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 6092 Street Name: SMITH RD Site Zip: 28168 Township: BANDY'S Fire Code: PROPST City Code: COUNTY State Road: 2040 Total Bldgs Value: $106,100 Land Value: $17,300 Total Value: $123,400 Year Built: 1940 Year Remodeled: 1988 Last Sale Date: Last Sale Amount: Neighborhood: 89 Watershed: Watershed Split: Voter Precinct: P2 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BANOAK Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011802 Census Block 2010: 3015 Small Area Plan: PLATEAU Agricultural District: PROXIMITY Printed: Friday, January 08, 2010 09:09 AM A CATAWBA COUNTY, NC CO I00-A South West Blvd PLAN RECEIPT 3 Newton, NC 28658- 0 (828)465-8399 Tuesday, February 16, 2010 -184 Z sM www.catawbacountync.gov Plan Case: EHPR-2-10-3892 Invoice Number: INV-2-10-259624 Environmental Health Plan Review Invoice Date: 02/16/2010 Site Address: 6092 SMITH RD, Vale, NC APPLICANT OWNER RONALD FULBRIGHT RONALD FULBRIGHT 6092 SMITH RD 6092 SMITH RD NC NC 704-462-1974 704-462-1974 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 02/16/2010 Check 4629 $300.00 $0.00 Total Paid: $300.00 Payer: RONALD FULBRIGHT Total Due: $0.00 pLttu ecciPt;h2r3?2~c-c03a-%1<)'~~ ~j=tl-2crd8ti-!>~!?;.rpt 02/16/2010 11:38 Catawba County, North Carolina This map product was prepared fi-om the Cataix ba County. RC, Geographic Information System. ~i Catmvba Count, has made substantial eforts to ensure the accuracy of locution and labeling information I contained on this map. Catawba Counrv protrtoies and recommends the independent verification ofany data contained on this map product by the user. The County of Catawba, its employees, agents and t personnel disclaim, and shall not be held liable for anv and all damages, loss or liability, whether direct, indirect or consequential which arises or ma}, arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 2687-02-95-2540 1 inch = 60 feet Prepared for: ~J f 1 i i 9.OC 28 , 94 3 R-40. 00 2.17A 254J9 r (342) 52 7- '~7_~_- 3 . THIS IS NOT A LEGAL DOCUMENT R-40 Friday, January 08, 2010 09:09 AM - I Y CATANJBA-LINCOLN-ALEXANDER DISTRICT HEALTH DEPARTMENT HICKORY, N. C.-NEWTON, N. C.-LINCOLNTON, N. C.-TAYLORSVILLE, N. C. j Phones Diamond 5-3883 INgersol 4-2011 REgent 5-5521 MElrose 2-3101 1 t PERMIT TO INSTALL SEPTIC TANK t PERMIT N0 PERMIT DATE 19 Owner ~`_t i ° Address Tenant .......Address Installed by.. A 'r Address . Location of Property 01 ~ fX ~.Z r p-...`. gth of trench Kind of tank Size.. Len NOTIFY HEALTH DEPARTMENT AT LEAST EIGHT HOURS BEFORE TANK IS TO BF INSPECTED i Final Inspection .19.Y r Approved Disapproved ( ) I ^ t Remarks: . t t First five feet of line from outlet from house should be of cast iron soil pipe. t ~ ~ w Sanitarian. i i i Sketch of tank and line showing dis- tance from dwelling and well on subject property and on adjoining property. t i a i t