HomeMy WebLinkAboutEHPR-3-11-9878.TIF $A • THIS IS NOT A PERMIT Case # EHPR -3 -11 -9878
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CATAWBA COUNTY HEALTH DEPARTMENT
1 CO `'C Plan Review Application for Environmental Services
842 sM Environmental Health Plan Review - OSWP
Pevisd dalz IMPROVEMENT - NEW WELL
& 1OB 3 j, l 1 N NAME TO APPEAR ON PERMIT
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CLAYTON HOMES # 81
SITE ADDRESS: 5324 HOPE RD, Vale, NC Pin#: 269702654292
NAME of SUBDIVISION:PLATEAU RIDGE ESTATES Lot # 2 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.689
DIRECTIONS: 10W/ LEFT PLATEAU RD/ LEFT SCHRONCE RD / RT HOPE RD/ ON LEFT
APPLICANT OWNER CONTRACTOR
CLAYTON HOMES # 81 REECE JONATHAN CLAYTON HOMES # 81 /CMH INC
1230 CONOVER BLVD 4606 HICKORY NUT RIDGE RD (UNLICENSED)
CONOVER NC 28613 GRANITE FALLS NC 28630 1230 CONOVER BLVDCONOVER NC
828 - 465 -3450 28613
828 -465 -3450
PRIMARY CONTACT: Contractor APPLICATION_F_OR:_N.e._ Construction
DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: N/A
NUMBER OF EXISTING BEDROOMS: SEWER TYPE: S .,, i .Tank
NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN : N/A
CALCULATED DESIGN FLOW:
Public water is **NOT ** available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: 2011 SW MOBILE HOME / 16 X 76 MEETS APPEARANCE CRITERIA; MUST FACE FRONT OF
PROPERTY; MUST BE UNDERPINNED; MUST HAVE 36 SQ.FT. DECK ON FRONT; AND TONGUE
MUST BE REMOVED OR SCREENED
PROPERTY EASEMENTS: NONE
_ PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS: 2
PROJECT DESC: SINGLEWIDE MOBILE HOME
PROJECT DIMENSION: 16 X 76
BASEMENT? No BASEMENT FIXTURES? No
APPLICATION FOR WELL CONSTRUCTION /ABANDONMENT /REPAIR
PROPOSED WELL TYPE: Individual Well ABANDONMENT TYPE:
WELL REPAI REQUESTED?
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: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828 - 466 -7291
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03/21/11 14:38
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Public CA Health De CO NTY Case # EHPR - - - 9878
Q I- ` Subdivision PLATEAU RIDGE ESTATES
Environmental Health Division -Plan Review
71 0 ''c' PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# 2
!8 2 sw PIN# 269702654292
Applicant/Owner CLAYTON HOMES # 81, 1230 CONOVER BLVD, CONOVER NC 28613
Site Address: 5324 HOPE RD, Vale, NC
Property Size: SF 0.689 ACRES
Directions: 10W/ LEFT PLATEAU RD/ LEFT SCHRONCE RD / RT HOPE RD/ ON LEFT
Minimum Setbacks: Front: 80 Side: 15 Rear: 30 Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Improvement Permit Fee 03/16/2011 $150.00 $0.00
Well Permit & Inspection Fee 03/16/2011 $300.00 $0.00
TOTAL FEES $450.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
03/21/11 14:38