HomeMy WebLinkAboutRBPR-10-2021-39078.TIF ,g,A
• THIS IS NOTA PERMIT Case# RBPR-10-2021-39078
ld „mp CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
18 2 9A Residential Building Plan Review- Building Alteration
IMPROVEMENT-AUTH_CONST
I.. )3 New Dame'
*Removed Owner ROBERT&ANDREA CLIFFORD,8747 JACOB FORK RIVER RD,VALE NC 28168
11:8283293275 C:8284555013 HOME:8283293275
Owner DANIEI,KOCH,642 PARK CIR,LINCOLNTON NC 28092
C:8284464503 DANKOCH67 @GMAIL.COM
NAME TO APPEAR ON PERMIT
Daniel Koch
SITE ADDRESS: 8747 JACOB FORK RIVER RD,VALE NC 28168 PIN# 266802581024
NAME of SUBDIVISION: Lot# TR 2 Section/Block
PROPERTY SIZE: Square Feet Acres 30.92
DIRECTIONS: Old Shelby South to Jacob Fork River RD to 8747
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 100 WATER SUPPLY: Private Well
DESCRIBE WORK: Adding a full bathroom to existing barn; from bathroom to septic-from well to bath
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES",then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? Yes
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: ACCESSORY STRUCTURE
FACILITY TYPE: Accessory Structure OTHER DESCRIPTION:
DESCRIPTION OF Single family dwelling&barn
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE: 60x60 barn;
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
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CATAWBA COUNTY Case# RBPR-10-2021-39078
Public Health Department Subdivision
d . Environmental Health Division PIN# 266802581024
OA PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: (DANIEL KOCH),642 PARK CIR,LINCOLNTON NC 28092
( Daniel Koch)
Site Address: 8747 JACOB FORK RIVER RD,VALE NC 28168
Property Size: Square Feet Acres 30.92
Directions: Old Shelby South to Jacob Fork River RD to 8747
Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat
=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for
septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the
proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements
I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are
granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely
responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation
can be performed.
The undersigned is the owner of the property or legal agent of the owner.
Date: Signature of Applicant or Agent
If you need further infonnation or assistance please call 828-465-8270
AREA1
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FEENAME DATE FEE AMOUNT
Authorization to Construct Fee(New/Expansion) 10/15/2021 $150.00
Fee
Improvement Permit Fee 10/15/2021 $150.00
TOTAL FEES S300.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
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