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Home My WebLink AboutEHPR-3-10-4253 (2).TIF A CMG THIS IS NOT A PERMIT Case # EHPR-3-10-4253 CATAWBA COUNTY HEALTH DEPARTMENT U Plan Review Application for Environmental Services Ig~}2 SM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER CONTRACTOR CARL (RICK) ADAMS CARL (RICK) ADAMS 9048 JACOB FORK RIVER RD 9048 JACOB FORK RIVER RD VALE NC 28168 VALE NC 28168 828-514-1296 828-514-1296 NAME TO APPEAR ON PERMIT CARL (RICK) ADAMS Pin#: 266801178426 SITE ADDRESS: 9048 JACOB FORK RIVER RD, Vale, NC DIRECTIONS: IOW / RT PROVIDENCE CHURCH RD / LEFT OLD SHELBY RD / RT JACOB FORK RIVER RD / 1-1/2 MILES CROSS SMALL BRIDGE / I ST DR ON RIGHT(go to drive at mailbox 9048, all way to end) NAME of SUBDIVISION: Lot # A Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.759 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 63 X 46 Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes 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: 17 X 24 ACCESSORY BUILDING (POOL HOUSE) Has any grading, removal, or addition of soil been done to this property? If so, describe Are there easements/right-of-ways recorded on this property? NONE 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: 3 = ` Z-4:;' 1 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application cdtT 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 80 FEE NAME DATE AMOUNT Side 5 Improvement Permit Fee 03/09/2010 $150.00 Rear 5 TOTAL FEES Max Hght $150.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/09/10 1 1:5 8 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check X New Well Permit E] Replacement Well ❑ Well Abandonment El 1. Name to Appear on Permit APlax &,Ak- A.C, 2. Permit Requested By ~,c'J:a Business Phone ~L~-315-a19~eL Address loZ Nrd c ,[J(I Air-KpA, t k- e).$4.-al Home Phone 3. Property Owner nr-k4' 1 eSe~ ~tda~.►S Business Phone!&- -S14- 1Z-9t. Address QO►Wn, -SeCvlo r-ar\4% Home Phone 4. Name of Subdivision IJIA Lot # Section/Block/Phase Property Address go•At`S S~vlo ~~r~ 1~'✓ei lZ~ Directions to Property: NcU3 yp p/tv; cc. C2.,~~ : icr, ~KM I~kF o}.-t o o ~r~ S 1%cl bti Qd -Fr.~.~,., S g F-b/ K f: ✓e Jea 5. Property Size: Square Feet Acres 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 issuance. This may prevent the need for system size increase in the future. Basement: Ono Water Using Fixtures in Basement: yes/no No. in Family Z. Whirlpool Tub yesA Gallon Capacity Total Number of Bedrooms MULTIPLE FAMILY RESIDENCES: Units/ 00 A DAY CARE: Number of Children A-- jl RESTAURANT: Seats 6VA.. Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees Ist 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes /(9) If so, describe: 9. Are there easements/right-of-ways recorded on this property? 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 [ ] County/City/Township water line **If No, a Well Pen-nit must be issued with the Septic Permit.** 11. Well Type Applying For: [oorIndividual 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 TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.** Date ' lP Signature of Owner or Agent CATAWBA COUNTY PERMIT ~A co ZONING AUTHORIZATION R Accessory Structure y P. O. Box 389 v~► PERMIT NO: ZONR-3-10-5255 100A Southwest Blvd APPLIED: 03/09/2010 Newton, North Carolina 28658 ISSUED: 03/09/2010 1 84 2 SM Phone: 828-465-8380 EXPIRES: 09/05/2010 FAX: 828-465-8484 www.catawbacountync.gov APPLICANT OWNER CONTRACTOR CARL (RICK) ADAMS CARL (RICK) ADAMS 9048 JACOB FORK RIVER RD 9048 JACOB.FORK RIVER RD VALE NC 28168 VALE NC.28168 PROPERTY ID#: 26680 1 1 78426 CENSUS TRACT: STREET ADDRESS: 9048 JACOB FORK RIVER RD, Vale, NC LOT# A PROJECT DESCRIPTION: ACCESSORY BUILDING (POOL HOUSE) DIRECTIONS: COMMENTS: PVT ACCESSORY BUILDING (POOL, HOUSE) 17 X:24 IN SIDE REAR YARD FLOOD ZONE? OWNER TYPE: Residentia((Private) REQUIRED SETBACKS 100 YEAR FLOOD ZONE PLAIN? No LAND OWNER: FLOOD PLAIN, STRUCTURE? No MAX HEIGHT: 45.00 FRONT: 80.00 SIDE: 10.00 REAR: 5.00 SIDE 1: VALUE: 38000 CORNER: SIDE 2: 1. Before an inspection can be made by the Building Inspection Office, the applicant must pull a string to designate the side and rear property lines where the structure is being placed or constructed. 2. Accessory structures shall only be located in side or rear yards. 3. Accessory structures shall not be attached in any way to the principle structure - 4. Accessory structures shall only be used for private residential purposes. 5. Manufactured homes shall not be used as accessory structures. 6. Accessory structures may not be used for living purposes. FEE DESCRIPTION DATE FEE AMOUNT Residential Zoning Fee 03/09/2010 $25.00 TOTAL FEES $25.00 The applicant hereby certifies that all information and attachments to this Certificate of Zoning Compiliance are true and correct and acknowledges that this permit was issued on the basis of the information required herein. The applicant further acknowledges that any construction, alteration or addition which differs from this application shall be subject to removal or alteration so as to bring said structure into conformance with the specifications and standards of the Catawba County Zoning Ordinance. Such corrective action shall be at the expense of the applicant. It is the responsibility of Applicant to comply with all existing deed restrictions pertaining to the property. Issuance of this permit is not certification of such compliance and does not relieve Applicant of the duty to comply. "This Zoning Authorization Permit shall expire six months from the date of issuance unless a building ,74 is secured and remains active. APPLICANT NAME (PAINTED) APPL CAN IGNATURE ZO ING AP OVED BY 4.w~ ~1z°\~~ lw ZONING FEES ARE NON-REFUNDABLE COMPANY NAME r rrnii 03/09/2010 12:05 Page 1 oft ~4'A Cp CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE ' Newton, NC 28658- V (828)465-8399 Tuesday, March 9, 2010 184 sM www.catawbacount/nc.gov Plan Case: EHPR-3-10-4253 Invoice Number: INV-3-10-260232 Environmental Health Plan Review Invoice Date: 03/09/2010 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/09/2010 Credit Card -1 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 pl,jninvoice;%?><u4f I-fa10-45f'~-3a9e-84b2I_'s2Pi1Stlc;.rpt 03/09/2010 12:18