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Home My WebLink AboutRBPR-07-2012-15950.TIFaePa 1842 sM THIS IS NOT A PERMIT Case # RBPR-07-2012-15950 CATAW13A COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New IMPROVEMENT - AUTH CONST - EXPANSION Applicant DUSTIN DELLINGER, 910 ISLAND FORD RD, MAIDEN NC 28650 H:980 -429-0168C:828-855-8857 Owner DUSTIN DELLINGER, 910 ISLAND FORD RD, MAIDEN NC 28650 H:980 -429-0168C:828-855-8857 NAME TO APPEAR ON PERMIT DUSTIN DELLINGER SITE ADDRESS: 910 ISLAND FORD RD, MAIDEN NC 28650 PIN # 364615546861 NAME of SUBDIVISION: Lot # 1 Section/Block PROPERTY SIZE: Square Feet Acres 2.03 DIRECTIONS: 321 S/ THRU MAIDEN / LOT ACROSS FROM LIVING WORD CHURCH BEFORE COUNTY LINE PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well Public water is **NOT** available for this property. DESCRIBE WORK: NEW SINGLE FAMILY DWELLING W/ATTACHED GARAGE APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF SW MOBILE HOME / REMOVED EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 3 PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 70 X 35 # OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? PLUMBING REQUIRED? Yes 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. C(%� Date: l S't �— Signature of Applicant or Agent Q'LL 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 AREA1 MINIMUM SETBACKS FRONT: 40 SIDE: 12 REAR: 30 MAX HEIGHT: 19 - ehapplieation 07/05/2012 16:36 Page I of 4 �A CATAWBA COUNTY Case # RBPR-07-2012-15950 "7th 1 Public Health Department Subdivision Environmental Health Division PIN# 364615546861 ^. PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 J� SM NAME ON PERMIT: DUSTIN DELLINGER, 910 ISLAND FORD RD, MAIDEN NC 28650 Site Address: 910 ISLAND FORD RD, MAIDEN NC 28650 Property Size: Square Feet Acres 2.03 Directions: 321 S/ THRU MAIDEN / LOT ACROSS FROM LIVING WORD CHURCH BEFORE COUNTY LINE FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/05/2012 $150.00 Fee Improvement Permit Fee 07/05/2012 $150.00 TOTAL FEES $300.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) I:() - chapplicaiion 07/05/2012 16:36 Page 2 of 4 0 I_ W 4 C V W m H Z 0 V H z FCS C cca Z THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT $� Application for Environmental Services Page 1 1842 SM Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address q 1 o T514hd -Forj Subdivision Ma.Jl�e1^ ,N L 2L (s Lot # Acres Section/Block/Phase Driving Directions to Property E /6'L(,„c n C-04mu IAAA L��;� �� P��Skk 1 0 NAME TO APPEAR ON PERMIT? 0 Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Owner Contact Information Name 1)U%r\ ell�v ,r Address qlU 1$I,,v)j Ao d (ZJ Phone $avo- %SS- 885 7 Contractor Contact Information Name (jcbia N\V. ,s,Cw Cell Phone A! C Cell Phone ej$r�- y ay- pl t � Address -�S�LG Q,,- 10 S kou/ i (Zed Mq Phone 3og-19y3y I Cell Phone nr, WHO WILL BE THE PRIMARY CONTACT? 2fowner ❑ Applicant ❑ Contractor Description of Existing Structures on Site . D a R 111 Id h Q S Pee,, reirDved # of Bedrooms * j Structure Dimensions I y r)o # of Occupants Basement ❑ Yes[ No Basement Fixtures ❑ Yes X]No Planned FLlture Additions or Improvements (Building Permit NOT requested at this time) Describe ; ll.,. '), i-io-ir h0 ffJ Proposed FIItUre Structure Dimensions # of Bedrooms *t if applicable se`s Are there easements or right-of-ways recorded on this property Yes ❑ No Describe 14,F+ S'( -Le o -F Dvof�t--,, L46' 0d c4d r 4 of- Is a public water supply available on or adjacent to the above property ** ❑ Yes 21&0 Check type available ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Existing water supply in use Q Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) ,�A G THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 1842 um Pro osed Facility Type Primary Residence � New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description pn JCS K Structure Dimensions ' 70 # of Occupants 3 Basement ❑ Yes &No Basement Fixtures ❑ Yes ❑'Slo ❑ Accessory Structure(s) Describe # of New Bedrooms * j if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit*'1 Total # Bedrooms *f Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial I Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on- site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. j If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. 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. CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental Health 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 valid for 5 years or may be non -expiring under certain specified conditions. Improvement Pen -nits and Well Permits are transferrable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not trans f le Signature of Owner or Agent - Printed Na e %f Owner or Agent _ ,,,A(J v , (�,, ��] ;�,�rV Date —7�y ! i L �l Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Selected Parcel Number: 3646-15-54-6861 1 inch = 100 feet Prepared for: 2 789 43 ` f`\ 1.02A Uat 67-81 4902 / `� l'39 0 0 19 � 20.78 Z'~ ----J I � � / �r r ✓ r'" � � / �,j'' ■ 1 �`} 2.03A 61 ` 3.21A 2756 Q 6r 3�. ; 1330 O / I t 6 52� N 00 r9sJ THIS IS NOT A LEGAL DOCUMENT Date:.7�/5/2012 Tin e: 3:49:50 PM F Mkvo":� j8 83 R-20 TOWN OF MAIDEN PLANNING DEPARTMENT ZONING PERMIT PHONE (828) 428-5000 FAX (828) 428-5017 TDD 1800-735-2962 TOWN OF MAIDEN, 113 W. MAIN ST., MAIDEN, NC 28650 ZONING PERMIT NUMBER: M48-2012 PIN#.6,161_rga686i, x64615544903 DATE: JUNE 27, 2012 IOWNERVTENANT/CONTRACTOR: DUSTIN DELLINGER BUSINESS NAME: PHONE: 855-8857 PARCEL ADDRESS: 910 Island Ford Rd. Maiden, NC 28650 MAILING ADDRESS IF DIFFERENT THAN ABOVE: 910 ISLAND FORD RD. MAIDEN, NC 28650 SUBDIVISION: AREA:O. ZONING: R-20& & WATER SHED: NO FLOODPLAIN: NO TOWN WATER: NO TOWN SEWER: NO USE (CHECK ALL THAT APPLY) PROPOSED USE: BUILD 1426 SQFT HEATED AND 528 SQFT GARAGE HOUSE, REMOVE EXISTING MOBILE HOME. ALTER_ ACCESSORY _ CHANGE OF USE _ DEMOLITION _ENLARGE_ ERECT_ MOBILE HOME _ NEW CONSTRUCTION X OCCUPANCY CHANGE _ REMODEL _ REPAIR_ SIGN OTHER well, septic, electrical, plumbing, building, HVAC ZONING REQUIREMENTS SETBACK REQUIREMENTS: FRONT: 40' SIDE: 12' STREET SIDE: 15' REAR: 20% LOT DEPTH UP TO 30' ACCESSORY USE SETBACK: NOT PERMITTED IN FRONT YARD OR WITHIN 15' OF ANY STREET RIGHT -OF WAY OR 5' FROM LOT LINES. OTHER SETBACK REQUIREMENTS: 20% MAXIMUM IMPERVIOUS SURFACE, BUILDING HEIGHT SHALL NOT EXCEED 35' UNLESS DEPTH OF FRONT AND SIDE YARD SETBACK IS INCREASED V FOR EVERY 2' IN BUILDING HEIGHT OR FRACTION THERE OF. THE ABOVE DESCRIBED PROPERTY HAS BEEN FOUND TO BE IN COMPLIANCE WITH THE TOWN OF MAIDEN ZONING ORDINANCE. 1 d e4in AY\Arew 1a'.l11nwer IS HEREBY AUTHORIZED TO APPLY J FOR APPROPRIATE BUILDING INSPECTIONS AND HEALTH DEPARTMENT PERMITS FOR SAID PROPERTY. SIGNATURE OF APPLICANT g DATE 07 202 SIGNATURE OF ZONING ENFORCEMENT OFFICER DATE ************************************************************************************************ ALL PERMITS EXPIRE (6) MONTHS AFTER DATE OF ISSUANCE OR AFTER (1) ONE YEAR LAPSE IN WORK. ************************************************************************************************