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Home My WebLink AboutAUTH-06-2022-174624.TIF (4 catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 7/26/2022 Owner(s): Robert Lawhon Mailing Address: 342 6th St NW Hickory,NC 28601 Property location/site legal description: 8765 Jacob Fork River Rd,Vale PIN: 266801485389 Improvement Permit(IP) IMPV-06-2022-174622 Date Issued 6/27/2022 Authorization to Construct(AC) AUTH-06-2022-174624 Date Issued 6/27/2022 I, ,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 1508 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 Illg—25%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 un.•rstand and agree that the revocation of a permit that takes effect Immediately is in my best interest. I understand that by signing this for • . agree that I do not want to appeal the permit revocation. I understand that I am not required to relinquish my ap -al rights ut •• this is an option available to me so I do not have to wait 30 days for the revocation of the permit to tffeu. • Signature of Propert Own : — Date Signed: c P LA 2 NCDHHS/DPH/EHS/OSW Revised May 2015 catawbacountync.gov Environmental Health (ctcwha County Government (enter 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8210 MAKING. LIVING. BETTER. catawba county public health 7/26/2022 Robert Lawhon 342 6th St NW Hickory, NC 28601 Subject: Notice of Intent to REVOKE the Improvement Permit and Authorization to Construct for 8765 Jacob Fork River Rd,Vale PIN 266801485389 Catawba County Permits IMPV-06-2022-174622 and AUTH-06-2022-174624 Dear Mr. Lawhon: 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 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 150B. 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 Cntcwbc County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER: 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 7/26/2022. 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 150B-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, Cheyanne Morgan, S Environmental Health Specialist Catawba County Public Health CATAWBA COUNTY ITia iPublic Health Department Subdivision ..-� Environmental Health Division PINK 266801485389 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# Site Address: 8765 JACOB FORK RIVER RD,VALE NC 28168 Name on Permit: ROBERT LAWHON Property Size: Acres 34.05 Directions: Turn R on Old Shelby Rd to Jacobs Fork, Land has black gate half mile down road on left Owner/Authorized Representative Acknowledgement of Permit Receipt certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. /`cettlie the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service RBPR-01-2022-39943, by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) jElectronic Image Transmittal/E-mail (Return receipt required) the property owner or authorized representative I have reviewed and understand the specific conditions ?(, of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC I8A.1900), and/or Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date:06/27/2022 Owner/Authorized Representative Signature Date ( 11,° 22 • Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) ic)Signature E, Date/Time CY ))l)� Method: Fax i Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yooPlease ttake a few momentts tto complette our custtomer service survey att http://www,surveymonkey.com/s/EHCusttomerService aIc w� ai,,'ik„,;y vi re-ni e1y6d1111ii 06/270.022 14.16 rf