JANUARY 12 2017 BUILD APPSRECEIVED lr. 2 .l 20t
NEW HA]IIOVER COI,NTY BUILDII'IG PER
APPLICATI I TYPE: RESIDENTIAL
PLEAS€ AI{SIIER ALI. QIJESTIOIS APPLICABLE TO YOUR PRO]ECT
"Proj ect Responsibiliq/
APPLICAiIT'S MllE: qr.-^." a,,i'r.rind .^h-:nv .r/a c1-
2ot+- blll
APPTICATTON
itumbe r
(Office Use)
s l'i nF }l6nFe
DEVELOPER: N
PRO]ECT ADDRESS:
SUBDIVISION:
I t PHOIE S: e1o-?q4-4599
0 CITY: wilmi-nqron liir*="BLOCK *:LOT *:
ST: Ig_ ZIP: 2s4o3
PROPERW Od{ER'S [\lAIi'lE: stevens Buildinq Comoanv PIOIE *:
O,{ER'S ADDRESS: 5?10 oleander Drive suire 2oo CITY: wilminqton
CO TRACTOR: Stevens Buildinq Companv LICEI{SE #: 31626
ADORESS: sflo oleander Dri.a.e Sllire 2oo CITY: ]4.!_Ltr-j_!s!e!_ ST : Jg_ ZIP : 2!g!a
E!,IAIL ADDRESS: cn i ^h^l c^hacr ai,ahcr i nah^ma<PTONE *: 910-794-8G99
PtDtlE #: e1o-332-Bs1sPROJECT CO{TACT PERSo{tl: sraci Nicholson
EXrSTI{G COI{STTCTrOI: ! ar-rrUrrOn !RENOVATION ! crnenar nrearns ! RELocArroN
Et, CONSTRUCTION:ERECT irEr{ RESTDEiTE o" ! mrrrOt TO EXISTI G RESIDEilCE
**PLEASE CHECX AIO ATSTER sELO{ ALL T}UIT APPLY TO YOUR PRO]ECT:
Arr GARAGE |Ui sr ! oer canaee _ sF tol SFPORCH
! surnoor'r
-sF
f] eoor-
-
sr ! sromce sHED _ sF
! enrrrrouse _ sF ! oecr SF OIHER:SF
TOTAL HEATED 5Q FT:1011 rorAL sQ Fr u{DER aooe, 1bo9 rorAL AREA SQ n, ltlob
TOTAL PROIECT COST lu"s rat : $120.000
Is Any ELECTRICAL, PLIIIBII{G or ltECtUltUCAI Work Eeing Done to the Accessory Structur-e? E YeS
If the project is a Relocation, is there a Natural Gas/Line on the Current Site? [
Is thene Electrical Pouen on this Building? l-l ves Mlo
dno
Yes EI no
PROPERW UsE / OCCUPAT{CY:srr{GLE FArrLy f] ouer-ex fl rouuousr
DESCRIPTION OF hIORK:Nau Fa<i.iFnr i:'l adnqt nr.t i dh
DISCI-A|irER I iereby certry har all informarba in this appEaion is conecr and all wo{kwi[ comply witl he StaE Buildmg tue md ail oher applicable Siats and to.at taws
and ordinances and r€gulatDns The NHC Devebprnent Servi:es Cencr will be notfi€d of afly charces in fle 49ro'/ed plans dld or change in cont'&bror
conaaciorjnbrmaton'"NOTE:AnyWorkParformedWOtleAppropriaEPemitswillbeanVblationoftheNCSta€Btdg Subjecl Up To Ssm.Oo"'
Od{ER/CO|{TRACTOR: slaiq sgsvsng SIG ATURE:
+,* + r,**,r *,r* !r + * i( * * * * * * * * ** * * *(IitI I JiSJ *,t,t*,t+,t*++t** {.+ )* + * *,*,t **,t *,t * i.)t**,t )t *,t *,* t*,f ****)t*
I5 THE PROPERTY LOCATED I A FLq'DPLAIN?Evrs Ero
EXISTII{G IIIP ERVIOIJS AREA:1651 *FT TOTAL ACRES DISTURBED: 1/3
mH IrPERvIots ,urt.j,z 2661 5Q FT Exrsr LArl) DrsruRBI{G PERiur: E ves [l rrctUATER:
SETER:to0o
creur I cofir4uNrry svsreu ! pRrvATE wELL fl ceurnal wtt-t-
crnua ! cEirrRAL sEprrc ! enrvnrr seerrc ! cour,n Nrry sysrEM
*** SEPARATE PERI'IITS REqJIRED FOR ELECT, MECH, PLBG, GAS EQIJIP, PREFABS & INSERTS
pAynEr{T rlErHODr fl casx I orec( (PAYABLE ro wc; I arenrcA ExPREss E nclrrso E orscovpn
,t,t*!tt,*+,r****+,tiot*)i,*,*** **** )t+*+ rt:i+*,*t,l *r(,t****,*,*,**i.+rt)* t{.++:***,*,t* *,*,*,t * ,1.,},i + **+ * **,* * * )*,8 )*l,l* * )*
zoNE: _ 0F FICE R:
(roR ofFrcE usE qrLY) iEvrsED DATE O4l11l12
SETBAC(s: F:_ LH:_ RH:_ B:_
Appnoval:- City:- DATE:- FLOOD:
-
BFE+2ft=
-
av
1150 frLl eil\fi
Coflment:PERiIIT FEE: $
oorr, olmlfu
f OF STORIES: I
')0lT - 3bA
Wz l'i-a 3
AF9L?€AST'S IIHEI
DEUEISB
FB6IESI ADDRE :
SUBD:VTSIOi!:
PROPERTY qd{ER,S iHE:
flffifl'S rffiRES:It4
C@I?RACiOR:
AOERESE:
EHA:IL ADORESg:
PRfiIECT MTAEI PENSM:
Esrc-sF Atuflenraroosr- sr tr DECK
PnoPa* IEE / octt!3rc'1.:
O}NE&/@I{TRACf,ER:
$Ehl FTAIEVER CBU[!?Y BU:LBING PER]'iE?
APPr.IcBlI$! ryPE: IiEIDESITIAL
PLt sE lt$El atl. gJesrtrIlts rppt.lEAlls m w[, pRo]ET
"Frqjact R€spoilsl,bgAtlP
+
SLOd( it:LgT €I
ProlE *:
APP'.!CAIIG{
ilunber
(ofirce lAo)
DAIE: , /r-lJ
33Pt -7f-4n<_,
Exrsril &SrRlrcrEfl: ff ar.rmerru I naoreTlm I oawnar nPnrn5 [ RELocaTrfl
tE{ cors.rRlrsi:Fr{'. f] =arcr eEr RE=DESEa or f] amrrio* To EEE it s RE_JDE$E
cEDLlisE olzu IIE lmGe BEtsr rLL ?tu? nDeLv t! voln rro58€T:Elrr emce
-
sF Elon
CI?Y:
:icE 5l s:L
o-
5F OTHER:
Y'E qplp<flrwousr
SX{SATTIRE:
ACCOI*IT *:
25?:?,9t0 E *:
,ffia t! clta- bll-Qt?e
art o!rtlb..-fara tsbr&B h@E
lDtbqr^0l-
--
.rY-ro.2(9o r,
GARI$-- sF tlpoRcr __sFL ) I 4 5p L,! sI0RlcE sItED _ sr
TOTAL iIEATEB SQ FT:
-
TffiTL SE FT ISEIR R@F:
-
?(rr&L ABEA Sq FT:
-
?gfAt Pf,llrEC? @S?salq : S s'l,ooL.. t! 9F S?mlES: _rs ary Et-ETrrcAL, rurEDt @ nEgneqal. Horr Bdrg DoiE to ttr *-r-r7ffi_f @V.* ft itOr+ th! projld rs a Ral0catim, !s theFa 3 r.unal es Line or th. cufpert sr".r Qftes I nors trer.e ElrctrLcat go$eF oo thls auildine! Ekes E= Bo
DGE fm ,IPEEYSOIIS trEfr: _Sq Fa mT{l rrtE DTSTIIRBD:Es tpEs,l 19 antA: _ 4 F? aq5r LFr Fr _... rr EEr Lep ggrruBEffi pEBnif: ff, ve fi u
Et?tst: tl.cFruA LI omnnrrv s!E-,E E pRrvArE $ELL I cennnr HEll
sEm, El-cfnn E mnrar- sE-Ec n E(narE sEsrrc fr *"n* ooro
rS fiE PEoPETTT lrcA]EB Er r EiloD,pt-fr:sl? n yEs iA_€o
ue: &.Lormrn:
r{Fr.ornt: tk citg
fw
:Jduse=.OAtE: r
Gl' Catga t3 cr!v!
r r:s[- u ,t_ , . e! lrE qr&E:!,
t!.1!- sl'. 1 _- s: 5 ' [ro,.lrnu", :er3n *r)FLO0Di _X BFE+Zftr _trPffii EE:Setgp45, Coor.l€L 6roc-L r$,usr r.{b'r ExrgntD PRsr TtrE 5ro€
Pfu,{C\Pt(L 6{?ucrrrE O$.$i€fie,Egr sro€ of 'fil€ St0r.crulf .
la ceD 0f nrE
DESCIUFiEIS Gs tOEl(:
-
P}{E
t+tf,
'!A SED*AiE DEBE:i3F!= r l{ra EE E\auar, rurdtas E i-tF lFa .*.pn$Gn nEnD! =** n_WfiSr5*iff='51 ffi'ffii*H;_*
"tltt+$t*"1'*!+l t-!ao*s"Fri{B?{c'o*+rcl**rrs.ianri+egaF.=a*++-----.+.r-++a""*.""+"+i"
iU )bt?
\\
&
NEW HANOVER COUNTY BUILDING PERMIT
' APPLICATIO,V ryPf; RESIDENTIAI
PLEASE ANSWTR ALL QUESTIONS APPLICABI-E TO YOUR PRO]ECI
-Prolect Responslblllty"
AppUCANT,s NAME: Prestige Pools Of Wilmington lnc.p61g 12-5-2016
9ROJECI AODRESS: 7844 River road 61ry. Wilmington ztP 28409
SUBDIVISION:
pROpERTy OWNER,S N4yg. Roger Hudson PIIONE {
owNER,s ADDRE5S: 7844 River road ctry. Wilmington ZIP: nc
LOT f:
coNTRAcToR: Pr€stige Pools of wilmington inc.BLDG LlcENsE {. 54579
16sg555, 5307 South College rd ctTy. wilmington gT. nc 21p.28409
EMATL AoDRESST prestigepoolsoi^,ilmington@gmail.com pr{gt!g, 910-509-2370
pRoJEcT CoNTACT pEx5g11. Shane p66xs,910- 232-5375
EXISTING CONSTRUSTIOiI: 3 Alteration C Renovation [: General Repairs
NEW CONSTRUCTIOI,I: ii EreatNew Residence E Addition to Existing Residence :l Relocation
.'TPLEASE CHECK AND ANSWTR BEIOW AI"L THAT APPI.Y TO YOURIEO'ECT'*'
i-l Att Garage (SF)_ i: Det 6ara8e lsF) ___ il Porch {SF)
i Sunroom (5F)_
Il Greenhouse (SF)
-
El Pool(sF) 510 a storage shed (SF)_
tr Deck {SF}fl Other (SF)
ls the proposed work chanSing lhe existing footp.int? E Yes = No
TOTAI" SQ FT UNOER ROOF Lfot praposed work)Heated:0
ToTAt PROJECT COST (Less Lot)r 541,400.00
lstheproposedworkchangingthenumberof bedrooms? E Yes E No
lsanyElectriral.PlumbingorMechanicalworkbeingdonetotheAccessoryStructureEYesEl,lo
lf the proiect is a Relocation, is there a Natural Gas Line on the cur.€nt site? El Yes E f{o
ls there Electrical Power on this Building? E Yes n No
Property Use/ o.cup.nry: O single Family D Dupler< E Townhoute
Des.ription ot Workr lnstallation of in qround pool
and spenficaaion5 or chanEe In contr.ctorlawr ard ordinances and resulations. Tle l{Hc DeveloPment Seiv.cet C€nt$willbe notified of anY ch
trform.tion. "'liOTE:AnY wo.k P€rfomed without th€ 3pptopriale permitswiilb€ in violation ol the up to 5500.00'r'
owner/contractor: 9!9!a[9!!t-
"Licenscd QudliJier' P;;i;;-
ls the propertylocated in alloodplain? E yes E t'to
Existirg lmpewious Area:
-
Sq tt Total Actet Disturbed:
New lmpervlous Areal !-- sq ft Eristlng Land Disturbing P€trniti fl Yes f] No
WATER; E CFPUA El community System E Private well E centralWetl E Aqua
SEwfR: 0 CFPUA El Community System E Private septic 0 centralseptic O Aqua
Zonei
-
Offi.er: *-- S€tbacks (F)
-
(tH)
-
(RH)
-
(8)
-Approval:
-
clty:
-
Date:
-
flood: (A)
-
(v)
-
(N)
-
BrE+2ft=
-commenti Pe'mit Fe!: s ?s
Printfffil
unhlated:
DET GARAGE
-
5F
POOL _ 5F
ffincH 3l.- sr
/o/7- 3Yo
L6-3s25
APPLICATION
Number
(office use)
PHO{e *: UQ q
sr : Nl Lzrp
5F
SF
ATT GA&A6E
--
SF
suNR@M
--
SF
GREENHOUSE
-
SF I oecx
DESCRIPTION OF I',IORK:
tu
NEW HANOVER COUNTY BUILDING PERMIT
APPLICATION TYPE.' RESIDENTIAL
PLEASE ANSI{ER ALI QUESTIOI{S APPLI€ABLE TO YOUR PRO]ECT
"project Responsibillty,
PROPERTY OI'INER' S MIrlE:
OhNER ., S ADDRESS: ?5
lo\
u.J lf\4 rnf
tlceus?ton#:AccouNr *, &9 I
L
COIITRACTOR :D
ADDRESS:crrY: r Jilrv-\inczh:rr sr:N-Lzrp: JSqO IEI,IAIL ADDRESS 3 T.C)SZ rnen@tar*ati onU.r-i trtin6c,orp.ffi PHor{E #:-'l(,)3-91@
PRolEcr coNTAcr pERsoN: Srlr7 V <cjaa-rF PHot'tE #:]-)-
EXISTING CONSTRUC
NEW CONSTRUCTION:
TION:A LIE RATION R€NOVATION GENERAL REPAIRS RE LOCATION
ERECT NEI4 RESIDENCE on ADDITION TO EXISTING RESIDENCE
**PLEASE CHECX AND ANSI,JER BELON ALL THAT APPLY TO YOUR PRO]ECT:
t CITY:t r,\
STORAGE SHED
TOTAL HEATED 5Q FT: iI.Atr.UI TOTAL SQ FT UNDER NOOr, iK8L[ TOTAL AREA SQ FT: IIAS
TOTAL PROIECT CoSTILessLotr I $ tODti:-.-,C # OF STORIES: _:_
rs Any ELEcrRrcAL, PLUI{BrNG or MEcHArrcaL tr,ork Being Oone to the Accessory structune? ff yes G{rf the pnoject is a Relocation, ls there a Natural Gas Line on the cupnent site? Q ves G_n/Is there Electnical Powen on this Building? Q V"r Qt6-
PROPERTY USE / OCCUPANCY:SINGLE FAMILY I ouer-ex fl rowurmusr
SF OTHE R:
\
ancl ordinances 8nd aegu,alions. The NHC Delelogment Services Centsr will be nctfied ol any changes in he apprcved Dlans and spactfcadons or changs in contracbr oacon!&brhbrmalan'-NOTE:AnyWorkPe.trrmedW/ClhoAppropriabpemitswilbeinViotationofl,\eNCslaE Subje.r b Fines Up To$500.00"'
q'INER/CONTRACTOR:t SI6NATURE:
++ + * ** *,t t* * * +** * * i. * * * )i * * * *(P.tnt irane)***++*t*t******+t**+*+**+*++*****t*,t**,t,i*rt+*t,|*)*,t,4,***t**+*+t,f,*
IS THE PROPERTY LOCATED IN A FLOODPTAIN?YES (U"nEr
TOTAL ACRES DISTURBED: . O
o
EXISTING IfiPERVIOUS AREA:
NEhI IMPERVIOUS AREA:
urtn: pfreun
sEhrER: l-fif-PUA
SQ FT
SQ FT EXIST LAND DISTURBING PERIUT:ffi ves C"d
(FOR OFFTCE USE OrLY) SEVrS€D OqrE O4l11/12
SETBACKS: F:- LH:- RH:- B:-
f] corrnururrv svsrer,r I pRrvArE wELL f] carrnql r,Je ll
CENTRAL SEPTIC pRrvArE sEprrc f] comr,rururw svsrrm
*++ SEPARATE PERI'IITS REOJIRED FOR ELECT, llECH, PLBG, GAS EqJIP, pREFABS & II{SERTS '**
PAYFTENT METHoD: f,t cosx QcxecK (PAYABLE ro r.rncl I BrLL accour{r I nc/vrsa Q orscwen
**,t*,i+***t*,tr)t***,t:1.f1.*,t+++*,t*****,lxx**,t*,**,1*+r*+:l+++++,1**,*,****+:i.***,ttrt+,r**t,F*'il.++'tt't++**+
ZONE: -- oF FICE R:
Approval:- CitY:-- DATE : _-.- F LOOD:
--AV
BF E +2ft=
N
PERF1IT FEE: $v fb
ApplrcAr{Trs ruereiP4frt-a{Oa'Cy_ulrjrnC CF t_^litrrninotrXr]nC.orre: l& lVtltuDEVELoPER: o --- T- --Jxore *: lUfLkfub-pRolEcr ADDRESS: 53.\ r.-Ja-rnr,.^.t- St, crry: L. rity\.\i,",d1Na -**;tEF-qsl
SUBDIVISION: BLOCK #: A lOr *,
o
oz
!
N'I T No Frr e No tnv lt
CL1trs LFP:)A
NEW HANOVER COUNTY BUILDING PERMIT
APPLICATTON IYPE.. COI{MERCIAL
PLEAsE ANsI,{E8 ALt QUESIIONS APPLICAB!€ TO YOUi PRO]ECT
"Project ResponsiblLity"
2at+'- 32Ltrffist:
APPLICATIOT'J
l{umber
(offl(e use)
I'lavfare Towa Cenler l,P OAIEt t2 /23/ t6APPLICANT'S NAME:
DEVELOPER;PHONE S:
PROIECT AoDf,ESS: 683? Main srreet
OCCUPANT/BUSINESS NAME :Suite .1115 lrTM ReLocaLion
EIiIAIL ADDRESS;sadams@dhoc. cont
pROllCT CoNTACT Pf,RSoNi steve Adams
r/
tural
NE|,J CONSTRUCTTONT f] eneCr NEll STRUCTURE
ACCESSORY STRUCTORE:
PHoNE #:336-315-1098
PHoNE S; 336-316-1098
((hc.r All rhnt Apply)
r'FAsr rRAcK fl srrr-r r'urrrr ! AoD To Exrsr srRUcruRE
CITY: Hilninqron ZlP , zo40s
CONTRACToRT DH Griffio consLlueti"on ,Lc LICENSE #: 35375
ADDRESS; 500 Creen Va1ley Rd, suite 301 CITY: Gleensboro sT:IL zIP: 27408
EXIST CONSTRUCTION:
ll Relocatlon, is there a Na
ALTERATToN l-'l nrrovlttor,r I-l erHenal nrplrns l-l RElocarroN
Gas Line on rhe Eilrenr site? EY;ENo ls sroc spi xleneoz [| v.. [ruo
+
dl.g Code and ali olh€r applicable Slale
olans sndsoecillcarions
NC Sl.le Blds Code and
6F
If UPFIT - Ihe Shell P€rmit #:Is Elect power on this Buildj.ng EI yes E ruo
SQ FT
(Ou.IiL,
TOTAL PROJECT COST: S 22,82s.00 BUIID,NG HEIGHT:# OF UNITS:
TOTAL AREA SQ FT: rq! 5r' affecLed SQ FI PER FLR:# OF STORIES:
IOTAL SQ FI UNDER ROOF:
-
f OF STRUCTURES:# OF FLOORS:--
ACRES DISTURBED:Exsr I.AND DtsruRBrna penurrr l-lyes [-] Ho
NEW IMPERVIOUS AREA:SQ FT EXISTING IMPERVIOUSAREA:
conblr tub631,0. or no! Yot 5n bqulred tD cel fi. N.dontl En{..lon strnd.rd. lor Hl,t rdou Ar Potlurinb (NE6HAP) .t I910)707-S9SO .t l!.sl i O d.y! 9n;r b $.d.moldono,anyhdliyorbulldhg,506Arb.EtosWobSlr.:htbJ/\hr*.!pt.ibt.nc.us/6pl/.!b6!bsl6hmp.hunt
pRopERry usE: noFFrcE [nrsrauRAur [raencmrte [souc fleer lconoo OTHER;
WATER:
SEWER:-d]rfr CFPUA
CFPUA
ECOMMUNITYSYSTEM EWELL EIZONING USE CLASSIFICATION:
I]CENTRAL SEPTIC LI PRMATE SEPTIC I]COMMUNITY SYSTEM
", SEPARAIE PERUITS REOUINEDFOR ELECT. MECH. PLBG. GAS EOUIP. PAE'ABS &INSERTS ''
pAyivrENT METHoD: flcesx [cneo< (pAyABrE To NHc) flauentcnr'r exnness f]ucrurs.r florscowR
er}}ffitr}...ffffifrffi
(FoR OFFTCE USE ONLY) RE\,/I$ED DA.rE 1/11/12ZONE:_OFFICEB:_ SETBACKS: F:_LH; RH: BiApproval: Clty: DATE: FLOOD:
-_
_ BFE+m=_AVN
Commenti PERMIT FEE:
PRoPERTY O|,IINER.,S NAHE: Mavfare Toud cenrer LP PHONE #: 910 256-513i
OI,JNER'S AoDRESS: 6635 conservation leav CIty: wilminqton ST: Nc ZIP:28405
r*..r rs mrs A CHANGE oF occupANcy usel flves fiHo *.""
IF Yes, uhat u/as the Prevj.ous Occupancy Type? _ l,,hat ls the t{eu Occupancy Type? _
ARCH DESI6N PROFESSIoNAL: Goodrich 4rchitecture Blair coodrict PH:910-343-1065 NC RE6 ,t: ?434
ENGn DESICN PRoFESSIoNAL: PN: _ NC RIG ir: _
DESCRIPTIoN 0F NoRK: relocate AIM machine, decrease size of eouip room, lIlden sEorefronr, demo
ls food or bevorages pr€parod or servod ln thts smaure? f]Yes [lNo ls Th6 Property Locat€d ln Tho Fioodplatat f] ves fillo
914796A471 M H(226 .,,*,ruo,f@{,fu, - l2_,N 1
---:ii:..
,,. r: J,' 'NEW HANOVER COUNW BUILDTNG PERMIT
aPPLIAfron ryrE; RESIDEI{TIAL ITIOBILE HoitE
pLEASE pltr(T (LEAnty t lllsEt att QUE5TI0[5'}rcJlct iespoDstbil.itf
th L4 CITY:
(OCfl(. Urc)
DATE I l- r-l
PI{'NE *:
PrpllE *:a lo uss-': ot:
b
A.PP L ICAT TOtI
l{r.tber
APPLICANT'S IUUTE:
DEVE!OPER:
PROIECT AD0nESS!
S U8 D IVIS tot{ |
PR0PEf,TY Ol,r.lER's ih,rlE:L."!
OI{'{ER' S ADDR
zrp:
BLOCT I: Lor I!
PNO E *:
sT: !!3zIP:_
LIIE'TSE f:t5 ACCOUI.IT f:
CITY:sr:N( zrr: -" e{-s- [Ptol,E t: q \O- \r\s, zi6t _ts
._4.
*COTfiRACTOB I
ADORESS;
glrnsr
DES(RIPTIOII OF I{IRI(:
Cf r
EI4AIL ADD8E55:
PRO]TCT COTITACT PERSOTI:^
c\rin
(cHECr arL
ALL i'EI{ TOATLE }IOHE
IHAT APPLY)
fl nelocrrrot oF usED lrErLE HoltE
+
*
ollcr.tlB lalrq.rr,o.t,.brrrFh rll,rL.ue. tr drE rd.{rt.! !d, ruo. sbl.nlad.g csc. ts,.!.8q !rr*.r.sr.t _tlc.ltn-sitnru! ..! ,.tlAbB lh. rJrco.'d.F'r s.6r cosra !. i.d!i.' sr cnsto h L.t,ar,d..! Ba,t E ddr ! atle. h.r,.r,. oEr.lr rr.edbr --rorE:
^,,wdr t n rudwO rh &!.!ra! p.furl! D. ln Vldrb rr !l! !C lox l,J! Cd. bn t,al.t 6 Ec U, l.
OIdNER/CONTRACTOR:SIGT,IATURE:
rtai*aa,atr+iaaa.*+*$r++a
IS THE PNOPERTY LOCATM Ill A
PnoPEfi rY UsE/occuptr{cy: EtrRE
ataa+traratr+ritat+aaaaaa++ai+t*tar larraata*aa,a*raairaaraaa.a
F LOOTPI-AII{! Dyutffi
SIDEIC€ / orHE8r
HURNTCANE ZOI1E;
oECK: E yEs NO
TOTAL PRoIECT C05T rrr* r.orr: I t+i .1 h1 TOIAL ACRES DISIUiBED:
EXIST
SERIAL f:
COLOR;'ro-n
LAr'lD DISIURBII{G pERruT:YEs El r{o
r [12 E 3 sHxE oHEcToR: ffrAro cmnce , E yEs Ehio _ srsF poRcH: E ves drtr_ sr
MIER: I CFPUA
serrn: ! creua
cotlr I{ITY SYSTEH
CEIITRAL SEPTICE
r71frPBIVATE i{ELL I ctnrur werlpRtvATE sEprrc I coluurvrw svsrrr.r..r SEPARIIIE PEf,,lITS REQUIRED FON E!€CT, }tECIi, FLBG, GAS EQUIP, PRETAES & II{SfNIS *"
payrE T nEr{,o: E *, ! crerr lnavmlr ro ucl ! aru mourn I r,rcrusn I orscovu
rtvtsto a/11/rr
z0t{E: oFFrcER: (r(lr ottlrl ur ooY)
SEIBACXS: F: t-H: nH! !.
__, ,-- DATE:_ FLOOO:
--
BfE+2ft= ..-_
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