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Home My WebLink AboutEHPR-11-09-2683 (2).TIF ~$A C THIS IS NOT A PERMIT Case # EHPR-I 1-09-2683 r~ CATAWBA COUNTY HEALTH DEPARTMENT V 0„ `C Plan Review Application for Environmental Services 1842 S6 Environmental Health Plan Review - OSWP IMPROVEMENT - NEW WELL APPLICANT OWNER CONTRACTOR R. MICHAEL ISOM R. MICHAEL ISOM 3077 SW 1 ST AV APT A 3077 SW 1 ST AV APT A HICKORY NC 28602-1 82 1 HICKORY NC 28602-1821 NAME TO APPEAR ON PERMIT R. MICHAEL ISOM Pin#: 267803108778 SITE ADDRESS: 3297 RI-IONEY FARM RD, Vale, NC DIRECTIONS: HWY 10 W - TURN RIGHT ONTO RHONEY FARM RD - PROPERTY ON LEFT JUST PAST LYNN MITI. RD NAME of SUBDIVISION: Lot 9 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 3.9 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 30 X 50 Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 3 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees Ist 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: NO Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well X Community Well Municipal Semi-Public 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. ~J Date: /4/.z - D Q Signature of Applicant or Agent APAV 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 AREA2 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Improvement Permit Fee 11/12/2009 $150.00 Rear Well Permit & Inspection Fee' ` 41/12/2009 $300.00 Max Hght $450.00 TOTAL FEES *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/12/09 11:18 THIS IS NOT A PERMIT WLS #-/~~a CATAWBA COUNTY HEALTH DEPARTMENT A ication for Environmental Services Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit A'O. /P)iGhAS 1 - SDI 2. Permit Requested By , ~ief1AG/.Zsn~+~ Business Phone ( 2Y-c23Y ,2575 Address O oe w (ic)y. Home Phone Syooue 3. Property Owner a Z'3&-$% Business Phone i4..4 Address 3077-h t o0*Vf TW Aok~r 2k40 1 Horne Phone Z4^t 4. Name of Subdivision Lot # Section/Block/Phase Property Address l owe Directions to Property: W4jv D A A- SeAaa/ ! iv RAO" a k -1 R vpa /e 'us t G A4U g tae N o e t cA . 0-40 s o4 e.~e . 5. Property Size: Square Feet _ Acres y* ,*40 Date Platted/Recorded SD 6. TYPE OF FACILITY:~House Mobile Home Dimension of Structure/4400W 3D~c Bedrooms* *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_asa bedroom at the time of building permit issuance. This may prevent the need for system size increase in, the future. Basement: ( Deno Water Using Fixtures in Basement: yee No. in Family .3 Whirlpool Tub yes to Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees l st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes /C. ) If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes If so, describe: 9. Are there easements/right-of-ways recorded on this property? e / No 10. Is a public water supply available on or adjacent to the above property? Yes Check type that is available:[ ] Community well [ ] Semi-public well [ ] County/City/Township waterline **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For wndividual well [ ] Community well [ ] Semi-Public well 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 valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, 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 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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.** Date /f"/0 - 09 Signature of Owner or Agent le . OK'd b y C~„~~ Catawba County, North Carolina This map product was prepared fi ont the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County pronotes and recommends the independent verification of a» y 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 jo- any and all damages, loss or liability, whether direct, indirect at- consequential which arises or may arise from this map product o- the use thereof by any person or entity. Legend Selected Parcel Number: 2678-03-10-8778 1 inch = 100 feet Prepared for: J ~~QSJ J 70, 3.90A 8778 0) w ~p '0 hu W vs pee. ^0 At bti h fl sr ~PQ 138.00 39 o (1100) 15, THIS IS NOT A LEGAL DOCUMENT Monday, November 09, 2009 01:49 PM ' CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID.- 2678-03-10-8778 Name: ISOM RONALD MICHAEL Name2: Address: 3077 1 ST AVE SW APT A Address2: City: HICKORY State: NC Zip: 28602-1821 Account: 159743215 Calc Acreage: 3.9 Tax Map: 007 B 04001 LRK: 6765 Deed Book: 2907 Deed Page: 1036 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: Street Name: RHONEY FARM RD -33 Site Zip: 28168 Township: BANDY'S Fire Code: COOKSVILLE City Code: COUNTY State Road: 1002 Total Bldgs Value: Land Value: $26,300 Total Value: $26,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 89 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P2 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BANOAK Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011802 Census Block 2010: 1007 Small Area Plan: PLATEAU Agricultural District: Printed: Monday, November 09, 2009 01:49 PM A CATAWBA COUNTY, NC I00-A South West Blvd PLAN RECEIPT Newton, NC 28658- v (828)465-8399 Thursday, November 12, 2009 184 sM www.catawbacountync.gov Plan Case: EHPR-11-09-2683 Invoice Number: INV-11-09-257203 Environmental Health Plan Review Invoice Date: 11/12/2009 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Well Permit & Inspection Fee Fixed $300.00 Total Fees Due: $450.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/12/2009 Check 102 $450.00 $0.00 Total Paid: $450.00 Total Due: $0.00 p1anreceipt;e5e7'27t=7 92-4100-h oc-71461dcialdI,.rpt 11/12/2009 11:16