HomeMy WebLinkAboutEHPR-2-11-9461 (2).TIF E-74 C THIS IS NOT A PERMIT Case # EHPR -2 -11 -9461
111 CATAWBA COUNTY HEALTH DEPARTMENT
c5 ' ''C Plan Review Application for Environmental Services
' ` ` Z Environmental Health Plan Review - OSWP
8 4 sM Ptit e -$ ck ?kit EXS SYSTEM
c orDrj NAME TO APPEAR ON PERMIT
1 JASON SCRONCE
SITE ADDRESS: 3827 PLANTATION DR, Vale, NC Pin#: 269601096005
NAME of SUBDIVISION:PINE CREEK Lot # Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 2.059
DIRECTIONS: 10 W/ PLATEAU RD/ BEAR RIGHT ON BURTS RD / LEFT GILBERT SAIN RD/ LEFT PLANTATION DR/
LAST LOT AT END OF ROAD
• PPLICANT OWNER CONTRACTOR
SHELTON POOL AND SPA JASON SCRONCE SHELTON POOL & SPA, INC.
2424 MYRA LN 3827 PLANTATION DR 1412 E MAIN STLINCOLNTON NC 28092
LINCOLNTON NC 28092- VALE NC 28168 704 -201 -1030
(704)774 -8118 704 -462 -2096
PRIMARY CONTACT: Contractor APPLICATION FOR: l aw- Ermstr-u tion
DIM EXISTING STRUCTURE: 70 X 48 EXISTING FACILITY TY : House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 3 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is **NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: PVT INGROUND POOL 17 X 36
DESCRIPTION OF SINGLE FAMILY
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: PVT INGROUND POOL
# OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 17 X 36 ACC DWELLING? No
PLUMBING? No NONE # OF STRUCTURE OCCUPANTS: 0
I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal
system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for
evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is
transferable and may be eligible for a non - expiring date, but may be revoked if this information, site plans or intended use changes for the proposed
facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or
structure location should conform to applicable setbacks.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828 - 466 -7291
AREA2
(Minimum Setbacks: Front: Side: Rear: Side St: Max Height:
02/18/11 09:22
� CATAWBA COUNTY Case # EHPR - - - 9461
G Public Health Department
1` Subdivision PINE CREEK
a Environmental Health Division - Plan Review
PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot#
r8 2 sM PIN# 269601096005
Applicant/Owner SHELTON POOL AND SPA, 2424 MYRA LN, LINCOLNTON NC 28092 -
Site Address: 3827 PLANTATION DR, Vale, NC
Property Size: SF 2.059 ACRES
Directions: 10 W/ PLATEAU RD/ BEAR RIGHT ON BURTS RD / LEFT GILBERT SAIN RD/ LEFT PLANTATION DR/ LAST LOT AT
END OF ROAD
FEE NAME DATE AMOUNT BALANCE DUE
Existing Tank Check Fee 02/16/2011 $80.00 $0.00
TOTAL FEES $80.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
02/18/11 09:22