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HomeMy WebLinkAboutEHPR-2-10-3957 (2).TIF THIS IS NOT A PERMIT Case # EHPR-2-10-3957 CATAWBA COUNTY HEALTH DEPARTMENT v ^C Plan Review Application for Environmental Services 1842 5M Environmental Health Plan Review - OSWP IMPROVEMENT- AUTH CONST - NEW WELL APPLICANT OWNER CONTRACTOR SALLY MORTON Bradley Morton 2287 LYNN MTN RD 2287 Lynn Mountain RD VALE NC 28168- Vale NC 28168 (828)327-9358 NAME TO APPEAR ON PERMIT SALLY MORTON Pin#: 267804947168 SITE ADDRESS: 2287 LYNN MOUNTAIN RD, Vale, NC DIRECTIONS: HWY 10 W/ RT ON LYN MTN RD/ PROPERTY ABOUT I MILE ON RT NAME of SUBDIVISION: Lot # 1 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 5.628 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 50 X 60 Bedrooms 3 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 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so. describe. FUTURE CARPORT 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 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: 0/ C Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working ays of app ication date. If you need further 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 30 FEE NAME DATE AMOUNT Side 15 Authorization to Construct Fee (New/Expansion) Fee 02/19/2010 $150.00 Rear 30 Improvement Permit Fee 02/19/2010 $150.00 Max Hght Well Permit & Inspection Fee 02/19/2010 $300.00 TOTAL FEES $600.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 02/19/10 10:09 THIS IS NOT A PERMIT 3z CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental S7WelIPermit S IP AC S.T. Rpr. f- S.T. Exp. F- Exist. S. T. F- Replacement Well 1. Name to Appear on Permit: JA I I Y L eow. rke) P- - a 2. Permit Requested By: Business Phone: ~~3.27 935-x' Address: Home Phone: 3. Property Owner: LeeivA l~ ©.o ~a,I Business Phone: 3► ~-33~ Address: X23-7 _ LY tv V /n N A le- yd -1?/!V? 32~ -d &0 & Home Phone: - F- 4. Name of Subdivision: Lot Section/Block/Phase: Property Address: a13`7 Ly ~ ~fN &cd VA1 e. (V Directions to Property: F 7-AL Oul lb Jest - Ly /v(Y m1,j P n 4;Qj e-k~ APA by I M de- o d psh 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: C -House C' Mobile Home Dimension of Structure Bedrooms*~ iy r~~m that will be inrrnded for -1-ping at the tm ic uF construction or for future consideration shouia be noted as a h -.inx)m and counted on all appliottiuns. The numhPr of bedro, )m will'be confirmed by rooms identified on the house plans as a bedroom at the tin, -,-t 1): iilding permit issuance. ,This mad; prevent the i -l for systE.i.) i_,,, increase ii, t[w i inure. Basement: (,,Yes No Water Using Fixtures in Basement: Yes i No No. in Family: Whirlpool Tub: (-.,Yes (-.No Gallon Capacity: I 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: ~ No. of Employees 1st 2nd F- 3rd F-~ OTHER : (Specify) 7. Do you anticipate any additions to Facility? (v/es (-No If so describe r 6~( rp. o - 8. Has any grading, removal, or addition of soil been done to this property? Yes ~No If so describe 9. Are there easements/right-of-ways recorded on this property? (7 Yes No 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 r County/Cityfrownship water line 11. Well Type Applying For: Individual Well Community Well Semi-public Well F_ Irrigation Well r Geothermal Well 12. Monitoring Well Request:(-, Yes (7. ,No # of Wells: Name 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: 4C44 GeX.0- Print Form Catawba County, North Carolina This map product was preparedfrom 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 atry data contained on this map product by the user. The County of Catawba, its emplovees, agents and personnel disclaim, and shall not be held liable for anv and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this tnop product or the use thereof by any person or entity. Legend Selected Parcel Number: 2678-04-94-7168 1 inch = 250 feet Prepared for: ✓t 1 Plat 21 - 2118 2.34A 7219 30 J / ~ 71(38 E-, 48~A~~~/ Plat ''7_3-t 4~", gam ~G'~Qr a!~/~ .i{:, 1 C r' c 74 9 DA~ 1 THIS IS NOT A LEGAL DOCUMENT Friday, February 19, 2010 09:23 AMA CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2678-04-94-7168 Name: NATURE CONSERVANCY THE Name2: Address: 4245 NORTH FAIRFAX DR Address2: City: ARLINGTON State: VA Zip: 22203-1637 Account: 159758032 Calc Acreage: 30.95 Tax Map: 008 B02012 LRK: 7660 Deed Book: 3004 Deed Page: 1182 Subdivision Name: Subdivision Block: Lots: Plat Book: 21 Plat Page: 118 Building Number: 2287 Street Name: LYNN MOUNTAIN RD Site Zip: 28168 Township: BANDY'S Fire Code: COOKSVILLE City Code: COUNTY State Road: 1108 Total Bldgs Value: Land Value: $89,900 Total Value: $89,900 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 89 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P2 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-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: 2016 Small Area Plan: PLATEAU Agricultural District: PROXIMITY Printed: Friday, February 19, 2010 09:23 AM A CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE J' r~ Newton, NC 28658- 0 (828)465-8399 Friday, February 19, 2010 -o 1842 sM www.catawbacountync.gov Plan Case: EHPR-2-10-3957 Invoice Number: INV-2-10-259733 Environmental Health Plan Review Invoice Date: 02/19/2010 Fee Name Fee Amount Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee Improvement Permit Fee Fixed $150.00 Well Permit & Inspection Fee Fixed $300.00 Total Fees Due: $600.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 02/19/2010 Cash -1 $600.00 $0.00 Total Paid: $600.00 Total Due: $0.00 plan invoice ,d512033-J771-4 dt7-M5-00hSecJ 1I02/19/2010 10:13