HomeMy WebLinkAboutEHPR-01-2023-43261.TIF r_....
f i
va�i1; • e T.���BAron�ln r'a,ea
El I PR-()1-2023-4 3261 i
el
t 1111 - PuNic Health Department Sutxinrerun
[murnmenul Health Ulvtsron YIN, 373306298743
• PO Box 38q,100-A Southwest Blvd,`cwton NC 28655
\ ,
NAME ON PERMIT: (KRIS TI TUCKER). 1209 StORTIIFAD S I,CONOS'L R NC:28611
(Knstl Tucker)
Site Address: 4846 COtIN 1 Y I(c)S1E RD.CUKOS'I:R NC 28613
Property Size: Square Feet 39,204 00 Acres. _0.9
Directions: 321 N Bus,right onto W 20th St,led onto NC 16 Bus.left onto County Home Rd.at the roundabout lake the 2nd exit.
property on the nght
Completed applications are valid for a paned of 2 years Improvement Permits are valid witrt complete site plan=60 months(5 years) with comp:ate pet
=without exprrabon An Authorization to Construct will remain valid as long as the Improvement Permit is valid An Authorization to Construct issued for
septic repair n valid for 60 months(5 years) Permits may be revoked if the information on this appl.cation:site plan changes or A the intended use for the
proposed faubty lunges Permits may be revoked if site conditions are altered such that they effect permit conditions or nstallabori reQwrenrnts
i have read this appbcabon and certify Mal the information Fronded heron is true,complete and correct Authorized couny and state officials are
granted nght of entry to conduct necessary inspections to determine compliance with applicable laws and rubs I understand that I am solely
responsible for the proper tdentikabon and labeling of all property lines and earners and making the site ectessibie so that a complete site evaluation
;an be performed
The undersigned is the owner of the property or legal agent of the owne, /
Date 4 1-1 123 Signalurc of Applicant or Apcnt ,kr V ( 1.--- ---
11 you need lurther intonnahun of awvtan c rIc.rvc Lail 828-465-8270
AREA2
FF.ENASIE D.STF: tF:E ASIC)i 'IT '
Authorization to Construct Fee(New/Expansion) 01/25/2021 S ilea)0i)
Fee
Improvement Permit Fee 0Ii?5:2023 S150 00
Well Abandonment Fee 04:052023 S10)Ir)
TOTAL FEES S550.00
FEES ARE NON-REFI;NDAI3LE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMIMENCEE)
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
i
I
1
V
R
ci.rpplo.e.,,r t u' :i .:,;r
Pipe 2..1$
1
1
Y
` L fir'• .wi r0141111011111MPROMMINIMINIMMINIMMINIMMINI