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Introduction & Checklist

The intent of this application is to provide information in addition to the plans regarding the operational procedures of the facility.
Rules Governing the Sanitation of Hospitals, Nursing Homes, Adult Care Homes, and Other Institutions (15A NCAC 18A .1300) require that plans be submitted for approval prior to construction. Plans must be submitted with the necessary paperwork (see following checklist) to the Richmond County Health Department.
Submittal Checklist
1. Provide a complete set of plans drawn to scale including guest rooms, storage areas, laundry, trash can wash facility, dumpster area, and food service.
2. In addition, provide general plumbing, electrical, mechanical, lighting drawings, and room finish schedules.
3. Completed Application
Establishment Plans
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Acknowledgement*
I hereby certify that the information in this application is correct, and I understand that any deviation without prior approval from this Health Regulatory Office may nullify plan approval.
1. I understand.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
(Owner or Owner's Representative)
Date*
Date

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