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HomeMy WebLinkAboutIMPV-11-2021-161706.TIF catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 5/18/2023 Owner(s): Francis Gay Mailing Address: 4734 Sherhrnune 1 n Sherrills Ford,NC 28673 Property location/site legal description: 9234 Sherbourne Ln,Sherrills Ford PIN: 462903205500 Improvement Permit(IP) IMPV-11-2021-161706 Date Issued 11/29/2021 Authorization to Construct(AC) AUTH-11-2021-161711 Date Issued 11/29/2021 , '-4ZAwcs C Ay ,voluntarily relinquish my rights to pursue a formal appeal through the North (print full name) Carolina Office of Administrative Hearings pursuant to NC General Statute 130A-24 and 1508-23 and all other applicable provisions of Chapter 150E for the above referenced permit(s)(which includes the IPs and ACs)In order for the authorized agent/local health department to Issue the applicable permit(new IP and/or AC)for the site. I understand by completing this Form that the permit(s)for a IVa—50%Reduction (System description) will be revoked immediately by the authorized agent/local health department. I understand that the local health department's revocation of a permit can be appealed to the North Carolina Office of Administrative Hearings within 30 days of the revocation pursuant to the North Carolina Administrative Procedure Act. I understand that In order for the local health department to issue another IP and AC that the current IP and AC must be revoked. I understand that the local health department's revocation of an IP or CA is not effective until 30 days from the revocation or,if the revocation is appealed,at the time that the Office of Administrative Hearings issues a final decision. I understand that by signing this form and relinquishing my right to appeal the permit revocation at the Office of Administrative Hearings that the local health department's permit revocation will become effective immediately. I understand and agree that the revocation of a permit that takes effect immediately is in my best interest. I understand that by signing this form that I agree that I do not want to appeal the permit revocation. I understand that I am not required to reli quish my appeal rights but that this Is an option available to me so I do not have to wait 30 days for the revocation of the permit to take effect Signature of Property Owner: A.9%e: Date Signed: 0 S/z.S2 b Z-3 f NCDHHS/DPH/EHS/OSWP Revised May 2015 catawbacountync.gov Environmental Health Cctuwbc County Government Center 25 Government Drive 1 PO Box 389 I Newton NC 78658 1828.465.8210 MAKING. LIVING. BUHR. catawba county public health May 18, 2023 Francis Gay 9234 Sherbourne Ln Sherrills Ford, NC 28673 Subject: Notice of Intent to REVOKE the Improvement Permit and Authorization to Construct for 9234 Sherbourne Ln,Sherrills Ford PIN 462903205500 Catawba County Permits IMPV-11-2021-161706 and AUTH-11-2021-161711 Dear Mr. Gay: The Environmental Health Division of Catawba County Public Health intends to revoke your Improvement Permit and Authorization to Construct 30 days from the date of this notice. If the permits are revoked,you must apply for a new Improvement Permit and Authorization to Construct(IP/AC)and meet the requirements of the current laws and rules necessary to obtain a new I P/AC. You have a right to an informal review of this decision.You may request an informal review by the environmental health supervisor at the local health department. You may also request an informal review by the NC Department of Health and Human Services Regional Soil Scientist. A request for informal review must be made in writing to the local health department. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings 1711 New Hope Church Rd, Raleigh, NC 27609. You may write the Office of Administrative Hearings, call the office at (984) 236- 1850 or get a copy of the petition form from the OAH web site at http://www.oah.nc.gov . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150E-23 and all other applicable provisions of Chapter 1508. North Carolina General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. catawbacountync.gov Environmental Health Ccicwbc County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 I 828.465 8270 M K!NG. eEi If you wish to pursue a formal appeal,you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is 5/18/2023. Meeting the 30-day deadline is critical to your formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings,you are required by law(NC General Statute 150E-23)to serve a copy of your petition on the Office of General Counsel, NC Department of Health and Human Services, 2001 Mail Service Center, Raleigh, NC 27699- 2001. Respectfully, James R Ross, REHS Environmental Health Specialist Catawba County Public Health