HomeMy WebLinkAboutEHPR-01-2023-43144.TIF $A �G THIS IS NOTA PERMIT Case# EIIPR-01-2023-43 I 44
ICATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
18 2 sM Environmental Health Plan Review-OSWP
IMPROVEMENT
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Applicant DOMINIQUE THOMPSON, 1401 BRADSHAW ST,HIGHPOINTNC 27262
C:3365713101 DSBARNES11 aGMAIL.COM
Owner WILLIAM HEAFNER,PO BOX 1732,LINCOLNTON NC 28093
WILLIEH@PIEDCORP.COM
Paid By KHADESHA BARNES, 1401 BRADSHAW ST,IIIGILPOINT 27262
C:8032008106 KHADESHABARNES r GMAIL.COM
NAME TO APPEAR ON PERMIT
Dominique Thompson
SITE ADDRESS: 2320 DOBBIN CT,VALE NC 28168 PIN# 266903306130
NAME of SUBDIVISION: ELLENS WAY Lot# 24 Section/Block
PROPERTY SIZE: Square Feet 23,522.40 Acres 0.54
DIRECTIONS: right on providence ch rd to jacobs fork river rd,jacobs fork river rd to bayeigh dr, right on bayleigh,site on left.
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
ESS'ERIBE WOR> 2/10/23 NEW SITE PLAN WITH HOUSE LOCATION(APPROVED BY LAURIE IN ZONING)HOUSE SIZE AND
NUMBER OF BEDROOMS WILL REMAIN THE SAME. NEWADDRESS
PREVIOUS DESCRIPTION: IP only
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: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 32x76 10x10 front deck 10x15 back deck
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:
OTHER: INNOVATIVE: ANY: YES
Other described:
e6rppliati:,n 02/10/2023 13:38 Page I of3
.51;/ e CATAWBA COUNTY Case# E1 IPR-0 1-2023-43 1 44
ti(...it ,y Public Health Department Subdivision ELLENS WAY
!.� „c" Environmental Health Division PIN# 266903306130
PO Box 389,100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: (DOMINIQUE THOMPSON), 1401 BRADSHAW ST,HIGHPOINT NC 27262
(Dominique Thompson)
Site Address: 2320 DOBBIN CT,VALE NC 28168
Property Size: Square Feet 23,522.40 Acres 0.54
Directions: right on providence ch rd to jacobs fork river rd,jacobs fork river rd to bayeigh dr,right on bayleigh,site on left.
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: 9j)0 J3 Signature of Applicant or Age t
If you need further information or assis please call 828 465-8270
AREA1
FEENAME DATE FEE AMOUNT
Improvement Permit Fee 01/06/2023 S150.00
TOTAL FEES S150.00
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)
e6applir:awn 02/10/2023 13:38 Page 2 of 3
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