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Home My WebLink AboutEHPR-2-10-3898 (2).TIF a~~ C THIS IS NOT A PERMIT Case # EHPR-2-10-3898 Q. G ' CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 ski Environmental Health Plan Review - Repair SEPTIC MALFUNCTION APPLICANT OWNER CONTRACTOR BERTA ORTEGA BERTA ORTEGA 4736 RANDLEMAN ST 4736 RANDLEMAN ST CONOVER NC 28613 CONOVER NC 28613 828-441-0196 828-441-0196 NAME TO APPEAR ON PERMIT BERTA ORTEGA Pin#: 373417108714 SITE ADDRESS: 4736 S RANDLEMAN RD, Conover, NC DIRECTIONS: COUNTY HOME ROAD - TURN LEFT ONTO NOAH PATH - TURN LEFT ONTO RANDLEMAN ST - TURN LEFT AGAIN - 3RD ON LEFT NAME of SUBDIVISION: BROOKWOOD Lot # 17 & PT 1( Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.379 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 26 X 39 Bedrooms 2 Basement: No Water Using Fixtures in Basement:No 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 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: 1-;12'/1'l 0 Signature of Applicant or Agent 4&1,"/~ Z~ 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 AREA2 (FOR OFFICE USE ONLY) Zoning Approval _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Authorization to Construct (Repair) F02/16/2010 $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 16:42 THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ , Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit 2. Permit Requested By ~f Business Phone Address J~ Home Phone 3. Property Owner Business Phone Address Home Phone 4. Name of Subdivision Lot # vt- or ection/Block/Phase Property Address ,2 - L4 Directions to Property: i 5. Property Size: Square Feet Acres Q -2 Date Platted/Recorded 6. TYPE OF FACILITY: House 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 bedroom and counted on all applications. The number of bedrooms will be confinned by rooms identified on house plans as a bedroom at the time of building permit i uance. This may prevent the need for system size increase in the future. Basement: yes no Water Using Fixtures in Basement: yes no No. in Family 3 Whirlpool Tub yes/0 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 o 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? Yes / o 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: [ ] 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 TOJ BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date Signature of Owner or Agent Catawba County, North Carolina This map product was prepared from the Catawba County, NC, 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 arty data contained on this map product by the user. The Count}, of 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 mm, arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3734-17-10-8714 1 inch = 60 feet Prepared for: 00 r~ co 1ZT 19.95 7913 LO 00 7993 M 8962 t 9942 0921 6 09 0 8 [:11 10 11 50 12 75 75 80 80 75 19 94 ~ 66 75 75 18 80 17 16 J r _ 7 15 1 Cl c6 6756 ly, ~ ~ N 7735~~ _ _ co 8714 co 8792 _ 1 ~ 97~ 1--- j ~L---J 1 N ~f - j 80 80 80 34.5 2 409.77 SR 1660 45.5 80 8 (75) 1 ,t 1 a 142.1 1 THIS IS NOT A LEGAL DOCUMENT Tue, February 16, 2010 04:16 PM I CJ1 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3734-17-10-8714 Name: RAMIREZ LUIS MARTINEZ Name2: ORTEGA-RUVERA BERTHA ELISA Address: 4736 RANDLEMAN RD Address2: City: CONOVER State: NC Zip: 28613-8529 Account: 54307552 Calc Acreage: 0.38 Tax Map: 1420 06011 LRK: 50694 Deed Book: 2072 Deed Page: 1415 Subdivision Name: BROOKWOOD Subdivision Block: Lots: 17 & PT 16 Plat Book: 12 Plat Page: 44 Building Number: 4736 Street Name: RANDLEMAN RD Site Zip: 28613 Township: CLINES Fire Code: ST. STEPHENS City Code: COUNTY State Road: 1660 Total Bldgs Value: $54,500 Land Value: $9,200 Total Value: $63,700 Year Built: 1966 Year Remodeled: Last Sale Date: 3/1/1998 Last Sale Amount: $62,500 Neighborhood: 58 Watershed: Watershed Split: Voter Precinct: P29 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SNOW CREEK Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 010303 Census Block 2010: 2006 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Tue, February 16, 2010 04:16 PM ~ A Cp CATA"A COUNTY, NC 100-A South West Blvd PLAN RECEIPT Q+ Newton, NC 28658- V (828)465-8399 Tuesday, February 16, 2010 O 184 2 sM www.catawbacountync.Gov Plan Case: EHPR-2-10-3898 Invoice Number: INV-2-10-259647 Environmental Health Plan Review Invoice Date: 02/16/2010 Site Address: 4736 S RANDLEMAN RD, Conover, NC APPLICANT OWNER BERTA ORTEGA BERTA ORTEGA 4736 RANDLEMAN ST 4736 RANDLEMAN ST CONOVER NC 28613 CONOVER NC 28613 828-441-0196 828-441-0196 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 Cash -1 $300.00 $0.00 Total Paid: $300.00 Payer: BERTA ORTEGA Total Due: $0.00 1,1an n~cipt c ~dch~2-ii2~-IeU~-hf?'->~(~~c58?1a80! rpl 02/16/2010 16:41