HomeMy WebLinkAbout12-04 Application4tic� �oG Submittal Deadline
P/C Meeting
BOS Meeting
APPLICATION FOR CONDITIONAL USE PERMIT
FREDERICK COUNTY, VIRGINIA
1. Applicant (The applicant if the
f
_� _ - owner other)
NAME: (. (Ce( ` (.�
ADDRESS:
TELEPHONE
0
3.
Please list all owners,
the property:
occupants, or parties in interest of
tA?
The property is located at: (please give exact directions and
include the route number of your road or street)
4. The propeA has a road frontage of l ) 7/ feet and a
depth of
(Please be —exact) feet and consists of - A-,)3 acres.
5. The property is owned by (�� �i J.� � % T �
evidenced by deed from = J as
,L ci`l 1;1c�•1) C recorded
(
in deed book no. j% on prowner)
page
he
records of the Clerk—of the Ci cuit our
Co Countytof
Ei. Tax(Parcel) Identification
Magisterial District,
Current Zonings
(I.D.)N0.
i:° h k --i
7. Adjoining
,J
Property:
North
USE
Ck t Fvt i rt °
�61hn .
East
South
West
,�,
PAC -
lZONING_
TA iz,c i L
if 5%
S. The type of use proposed is (consult with the Planning Dept.
before completing).
9. It is proposed that the followin
g buildings will be
constructed:
10. The following are all of the individuals, firms, or
corporations owning property adjacent to both sides and rear
and in front of (across street from) the property where the
requested use will be conducted. (Continue on back if
necessary.) These people will be notified by mail of this
application: z
u
NAME ADDRESS
A
PROPERTY ID 1 �
,
NAME r
ADDRESSti
PROPERTY IDI
NAME 4- 1xW SS
PROi?ERT� ID# �,t 4 t E , �' "t if �; ('''. { ` , ; ;:.
ci
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ADDRESS r, rr o� rpt .
PROPERTY IDI
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`-ADDRESSNA14E
PROPERTY ID1'
NAME L-�Lv
ADDRESS
PROPERV-Y IDI
NAME ADDRESS
PROPERTY IDI
NAME ADDRESS
PROPERTY ID#
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11. Please use this page for your sketch of the property. Show
proposed and/or existing structures on the property, including
measurements to all property lines.
` A/
Val
cIN'1
12 .
Additional comments, if
I
any:
I (we), the undersigned, do hereby respectfully make application
and petition the governing body of Frederick County, Virginia to
allow the use described in this application. I understand that the
.sign issued to me when this application is submitted must be placed
at the front property line at least seven (7) days prior to the
first public hearing and maintained so as to be visible until after
the Board of Supervisors' public hearing. Your application for a
Conditional Use Permit authorizes any member of the Frederick
County Planning Commission, Board of Supervisors or Planning and
Development Department to inspect your property where the proposed
use will be conducted.
Signature of Applicant
Signature of Owner
Owners' Mailing Address
Owners' Telephone No.
r)12- I( a-
TO BE COMPLETED BY ZONING ADMINISTRATOR:
USE CODE:
R13NEWAL DATE:
F
� rawax.01
Sewage Disposal SysIt runs Construction Permit PAGE -OF 2-
s
cocntnc nwean of virginia Health Department
De�,arttttent of Head% � � Identification Number
�
'/� e_'- Health Dapa-tment Map Reference .2:4-
��: �� lrefvrTnatit►n
raNew �Repair ❑ Expanded ❑ Conditional F_1FHA ❑ VA ElCase No.
sed on the application for a sewage disposal system
construction permit filed in accordance
with Section
3.13-01, 9 construction permit is hereby issued to.
t Owner - P le- If GLOelr l_.
_ ,_- Telephone. - 6A��-
-2
j Address 3-F ��Y�rt�y' .'tea. �v'�s�� sr���t
disc z2G�3
j
I For a Type . - Sewage disposal system which is to he constructed on/at�
Subdivision — Section/Block - i_ot
Actual or estimated water use
r DES!GN
Water supply, existing: (describe) r1V25r L— L 1, 44_
"InTE: INSPECTION RESULTS
Water vqn* location: Satisfactory yes ❑ no ❑
comments
G. W, 2 Received: yes ❑ no ❑
not applicable ❑
I To be installed: class -
cased grouted —
Building newer:
auilding "prep: yes ❑
no ❑ comments
I r`' I.D. PVC 40, or equivalent.
` Satisfactory
Slope '1.25' per 10' (minimum).
J
1 ❑ Other
Septic tank: Capacity __ _-- gals. (minimum).
Pratreaftn snt unit: yes ❑
no ❑ comments
❑ Other _
Satisfactory
Inlet-outlet structure:
Inlet-outlet Structure: yes ❑
no ❑ comments
EdC 4fl 4°` tees or equivalent.
Satisfactory
n Other
i Pump and purnp station:
Pum & pump apt yes ❑
no ❑ comments
No i� Yes ❑ describe and show design.
Satisfactory
if yes:
i Gravity mains: 3' or larger I.D_ minimum 6" fall per
Conveyance method: yes "
no ❑ comments i
100', 1500 lb. crush strength or equivalent.
Satisfactory
Other
Distribution box:
Precast concrete with `__
Distribution box: yes ❑
Satisfactory
no ❑ comments
- ports.
Other
j Header lines: -"
He&der lines: yes ❑
no ❑ comments
Material: 4" I.D. 1500 lb. crush strength plastic or equiva-
Satisfactory
lent from distribution box to 2' into absorption trench.
Slope 2" minimum.
❑ Other
!
Percolation lines:
Plorcoletkm these: yrs ❑
no ❑ comments
Gravity 4'° plastic 1004 lb, per foot bearing load or
Satisfactory
equivalent, slope 2" 4' (min. max.) per 1041.
+tt--❑ Other
Absorption trenches:
Absorption tmncb"f: yes ❑
no ❑ comments
Square ft. required Z a : depth from ground surface
Satisfactory
to bottom of trench /., ; aggregate sjze
Trench bottom slope
center to center spacin4 '_._.; trench width 3 °
Depth of aggregate /3
Date _-- Inspected
and approved by:
Trench length 7-' ; Number of trenches 9
Sarsltarien
c H S. 202A I;"tsad &Sd 11-2
Health Department
>3 Z Zr
identification Number 7
Schematic dr erg of sewage disposal systi n and topographic features. PAGE Z OF �'`'
Show the lot lines of the building lot and building site, sketch of property showing any topographic features which may impact on the design of
the system, all existing and/or proposed structures including sewage disposal systems and wells within 100 feet of sewage disposal system and
reserve area. The schematic drawing of the sewage disposal system shall show sewer lines, pretreatment unit, pump station, conveyance sys-
tem, and subsurface soil absorption system, reserve area, etc. When a nonpublic dnnking water supply is to be located on the same lot show all
sources of pollution within 100 feet.
,-The information required above has been drawn on the attached copy of the sketch submitted with the application.
Attach additional sheets as necessary to illustrate the design.
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4 /3�T"-I AZ. .+ �.aGiE T7" rvt c c 1
� %.�'LefTz3-J /..✓ � � �1' .E T�r+f'e' 6°,"!+G✓-y`�'�° F"�^€'z-S l�.rt'BlrTi�rr $'t � �f- "f
rte,✓ jr, sir
The sewage disposal system is to be constructed as specified by the permit 2 -o -r attached plans and specifications
This sewage disposal system construction permit is null and void it (a) conditions are changed from those shown on the application (b) condi-
tions are changed from those shown on the construction permit.
;mm
No part of any installation shall be covered or used until inspected, corrections made if necessary. and approved, by the local health department
or unless expressly authorized by the local health dept. Any part of any installation which has been covered prior to approval shall be uncov-
ered, if necessary, upon the direction of the Department_
o Issued b 7---7TTNl Construction
Date: y :
Sanitarian Permit Valid until
Date: 8 eviewed by:
Supervisory Sanitarian
-----------------------------------------------------_----- ----,---
if FHA or VA financing
Reviewed by Date
C.H.S 2028 Rewsed 6/64
Supervisory Sanitarian
11-2A
Date
Regional Sanitarian