BOA agenda 121018 - cancelled due to weather

Browse Search

r EVALUATIONSITE •• PERMIT SECTION IIIMPROVEMENT PP rRMIT(Up to WO GPD) NUMBER OF S]TES X $1 PER S ' INDIVIDUAL LOT M SUBDIVISION ❑ RECOMBINATION❑ EXISTING S EXPANSION❑ ❑SITE REVISIT TO REISSUE OR MODIFY A VALID IMPROVEMENT PERMIT(Up to 600 GPD) $1W PER SITE EALH SITE EVALUATION CONSISTS OF UP TO 2 ACRES, FLOWS OVER 600 GPD REQUIRE ADDITIONAL FEES mmmm., THE FOLLOWING ARE REgUIRE12 BEFORE PROCESSING THIS APPLICATION FOR AN IMPROVEMENT PERMIT: U A TTE AN 12R PLAT SHOWING THE EXISTING AND PROPOSED PROPERTY LINES WITH DIMENSIONS AND THE LOCATION OF ALL PROPOSED STRUCTURES,ADDITIONS,OR IMPROVEMENTS WITH LABELED SETBACKS. U EXISTING AND ANY PROPOSED PROPERTY LINES/CORNERS MUST BE CLEARLY MARKED ON SITE. O THE APPLICANT IS RESPONSIBLE FOR MAKING THE SITE ACCESSIBLE FOR THE EVALUATION. O FOR NON SINGLE-FAMILY DWELLING APPLICATIONS,ADDITIONAL INFORMATION TO DETERMINE WASTE FLOW AND CHARACTERISTICS WILL BE REQUIRED. ❑ CONSTRUCTION AUTHORIZATIONf # ❑AUTHORI7.ATION TO CONSTRUCT FOR NEW CONSTRUCTION OR EXPANSION $160(Up to 600 GPD) ❑SITE REVISIT TO REISSUE OR MODIFY A VALID CONSTRUCTION AUTHORIZATION $•100(Up to 600 GPD) THE FOLLOWING ARE REQUIRED BEFORE PROCESSING THIS APPLICATION FOR A CONSTRUCTION AUTHORIZATION: U A FLOOR PLAN OF THE STRUCTURE MUST BE SUBMITTED. O A SITE PLAN OR PLAT MUST BE PROVIDED SHOWING:THE LOCATION OF THE PROPOSED STRUCTURES, DRIVEWAYS,ADDITIONS,EXCAVATIONS OR OTHER IMPROVEMENTS;PROPERTY LINES;DIMENSIONS;AND SETBACKS TO REFERENCE POINTS. O THE EXISTING AND ANY PROPOSED PROPERTY LINES/CORNERS MUST BE CLEARLY MARKED ON SITE 0 THE LOCATION OF PROPOSED STRUCTURES AND IMPROVEMENTS MUST BE STAKED ON SITE. THE CONSTRUCTION AUTHORIZATION MUST BE ISSUED PRIOR TO ANY CONSTRUCTION. SUBSEQUENT CHANGES TO THE SITE PLAN,FLOOR PLAN, R APPIJCATION WILLE AND 629MML OVER 60 GPD REQUIRE ADDITIONAL FEES. SECTIONSIGNATURE Q TOTAL AMOUNT DUE RECEIPT# ! e S`DO S40 IF THE RESULTING FLOW IS>6(X)GPD.FZNON•DOMESTIC WASTEWATER SYSTEMS. OR IF ADDITIONAL PERMITS ARE NECESSARY SE CHECK WITH ENVIRONMENTAL HEALTH TO DISCUSS THE AMOUNT OF ADDITONAL FEES. -THIS APPLICATION MUST BE SIGNED BY THE CURRENT OWNER OF THE PROPERTY OR THE OWNER'S LEGAL REPRESENTATIVE(eg.SPOUSE,POWER OF ATTORNEY,EXECUTOR,OR PERSON WHO HAS ENTERED INTO A CONTRACT OR LEASE WITH THE PROPERTY OWNER) ONLY ORIGINAL SIGNATURES CAN BE ACCEPTED. I AM THE PROPERTY OWNER OR THE PROPERTY OWNER'S LEGAL REPRESENTATIVE 1 HA VE READ THIS APPLICATION AND AUTHORIZE THE OCHD TO ENTER THE PROPERTY AND PERFORM THE SERVICE(S) REQUESTED. OWNER: DATE: Please mail or bring in the rs ges of this completed form, with payment including the signature of the owner*,a floor plan (where applicable)and a site plan as indicated. Please call our office if you have any questions about filling out this form or the amount of payment needed. Make checks payable to: Orange County Health Department Return first 2 pages to: Orange County Health Department Environmental Health Division 306-C Revere Rd. Hillsborough, NC 27278 a7/03 188