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Home My WebLink AboutEHPR-3-10-4345 (2).TIF g Cpl THIS IS NOT A PERMIT Case # EHPR-3-10-4345 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP EXPANSION APPLICANT OWNER CONTRACTOR RAY FORD RAY FORD 1661 DALE ST 1661 DALE ST NEWTON NC 28658 NEWTON NC 28658 828-514-0847 828-514-0847 NAME TO APPEAR ON PERMIT RAY FORD Pin#: 365910467646 SITE ADDRESS: 1661 DALE ST, Newton, NC DIRECTIONS: 16S/ LEFT COLEY FISH POND RD/ LEFT DALE ST AT END ON LEFT NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure 28 X 76 Bedrooms 4 Basement: No Water Using Fixtures in Basement:No No. in Family 4 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: 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 4inorking y. Any representation by yo Ouse or structure location should conform to applicable setbacks. Date: 1/4'A' Signature of Applicant or Agent An Environmental Health Specialist will contact you witf application date. If you need further information or assistance please call 828-466-7291 AREA 1 (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 03/12/2010 $275.00 Rear 30 Improvement Permit Fee 03/12/2010 $150.00 Max Hght TOTAL FEES $425.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/12/10 12:46 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT plication for Environmental Services Improvement Permit 0?VAuthorization to Construct ❑ Septic Repair ❑ Septic Expansion Existing Tank Check New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ I . Name to Appear on Permit Ra A fo-e-cQ 2. Permit Requested By 0,69y vA.) DsrGs i S .v cs✓'//. a=ii;;" Phone -S 1' T y 7 Address Home Phone 3. Property Owner. 45e '-p Business Phone Address 1661 0,i It S1• /1,~~cJ~o,✓ .dG 2196,S'9 _ -Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address 04k Directions Property: t D.v 1e 6) '4 s 5. Property Size: Square Feet Acres Z Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home _k"_ Dimension of Structure 2$,-Ir '7(o 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 confirmed 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: yeso Water Using Fixtures in Basement: yes&, No. in Family Whirlpool Tub yes/®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: S. 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 prope 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 [ J Semi-Public well 1 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 HAZ/a BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE I AN IONAL CHARGE.** Date Signature of Owner or Agent Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catmvba County promotes and recommends the independent verification of any data contained on this map product by the user. The County 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 at- may arise from this map product or the use thereof by any person a• entity. Legend Selected Parcel Number: 3659-1046-7646 1 inch = 60 feet Prepared for: 194 y4.4s /J C7- 277 Jr9 _ Plat 32--143 s~ s l t ~-~r1 Ir 1 o Cu 1 2.OOA 7646, o 00., f - I< 0 0 0 300.03 N C ,D C-7 o "GS ~ £ THIS IS NOT A LEGAL DOCUMENT Tuesday, March 09, 2010 11:23 AM Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information comained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catmvba, 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 may arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3659-10-46-7646 1 inch = 60 feet Prepared for: r ' 1 I ~ 1 it 9li u~ ~L~ ~;i?7 t1 `i -fit,` ~ ` k y tY 1W Plat 32 ~3~ ;i, fi• j•F' 4 iii + Jt . ,L'/'# a:. '1 fit: ~ s ;•T'^«cd 2.oo -3'0 d r 764.6 Tr i f,r. ply 1 % cc O " _ -3-0-01.03 j THIS IS NOT A LEGAL DOCUMENT Tuesday, March 09, 2010 11:23 AM - CATAWBA,000NTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3659-10-46-7646 Name: FORD RAY A Name2: FORD SHARON B Address: 1661 DALE ST Address2: City: NEWTON State: NC Zip: 28658-8204 Account: 21541800 Calc Acreage: 2 Tax Map: 063N 03013E LR K: 900072 Deed Book: 1816 Deed Page: 0888 Subdivision Name: Subdivision Block: Lots: Plat Book: 32 Plat Page: 143 Building Number: 1661 Street Name: DALE ST Site Zip: 28658 Township: NEWTON Fire Code: NEWTON RURAL City Code: COUNTY State Road: Total Bldgs Value: $500 Land Value: $17,300 Total Value: $17,800 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 117 Watershed: Watershed Split: Voter Precinct: P22 E911 District: COUNTY Zoning: R-30 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: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 2039 Small Area Plan: BALLS CREEK Agricultural District: Printed: Tuesday, March 09, 2010 11:23 AM p,A CATAWBA COUNTY, NC South West Siva PLAN INVOICE Newton, NC 28658- (828)465-8399 Friday, March 12, 2010 84 2 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4345 Invoice Number: INV-3-10-260406 Environmental Health Plan Review Invoice Date: 03/12/2010 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Authorization to Construct Fee Adjustable $275.00 (New/Expansion) Fee Total Fees Due: $425.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/12/2010 Cash -1 $425.00 $0.00 Total Paid: $425.00 Total Due: $0.00 plan mvoicc, ; 6t).i I eccc- I6d8-=4-~,a9-8b i6-617?, ~l(l~108%Ul.rpt 03/12/2010 12:46