HomeMy WebLinkAboutEHPR-05-2022-41184.TIF $A �G THIS IS NOT A PERMIT Case# EHPR-05-2022-41184
t „ n CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
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IMPROVEMENT
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Owner JARROD&SHANON ADAMS,7839 SAWGRASS LN,SHERRILLS FORD NC 28673-9422
H:7049964243 C:7049963758 HOME:7049964243 SHANON@ADAMSINVESTING.COM
NAME TO APPEAR ON PERMIT
Jarrod & Shanon Adams
SITE ADDRESS: 1657 BROWN CHAPEL RD,CATAWBA NC 28609 PIN# 470001098048
NAME of SUBDIVISION: Lot# 2 Section/Block
PROPERTY SIZE: Square Feet 43,560.00�Acr�es 1.0
DIRECTIONS: NC-10,right onto Hudson Chapp d,right onto Brown Chapel Rd,property on the right
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
DESCRIBE WORK: IP for property subdivision,4 bedroom 60x60 home on a slab
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? No
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? No
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: House OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 60x60
#OF NEW BEDROOMS:: 4
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?
EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES:
SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT):
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES
OTHER: INNOVATIVE: ANY:
Other described:
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„to!,: CATAWBA('OUNTY case#41111 EHPR-05-2022-41184
IT(..._.t. 2 Public Health Department Subdivision
Q —1 Environmental Health Division PIN# 470001098048
PO Box 389,100-A Southwest Blvd,Newton,NC 28658
s.
NAME ON PERMIT: (JARROD&SHANON ADAMS),7839 SAWGRASS LN,SHERRILLS FORD NC 28673-9422
(Jarrod&Shanon Adams)
Site Address: 1657 BROWN CHAPEL RD,CATAWBA NC 28609
Property Size: Square Feet 43,560.00 Acres 1.0
Directions: NC-10,right onto Hudson Chapel Rd,right onto Brown Chapel Rd,property on the right
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 information or assistance please call 828-465-8270
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FEENAME DATE FEE AMOUNT
Improvement Permit Fee 05/27/2022 $150.00
TOTAL FEES $150.00
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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