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HomeMy WebLinkAboutEHPR-11-09-2767 (2).TIF ~A C THIS IS NOT A PERMIT Case # EHPR-11-09-2767 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services Ig42 sM Environmental Health Plan Review - Septic Malfunction EP_MALFUN APPLICANT OWNER CONTRACTOR DAVID F LEWIS DAVID F LEWIS 2744 HONEYCUTT RD 2744 HONEYCUTT RD CLAREMONT NC 28610-8038 CLAREMONT NC 28610-8038 NAME TO APPEAR ON PERMIT DAVID F LEWIS Pin#: 375504714438 SITE ADDRESS: 2744 HONEYCUTT RD, Claremont, NC DIRECTIONS: HWY 16N, RIGHT ON SHELL HOLLAR, LEFT ON RESTHOME RD, 1ST RD TO LEFT (HONEYCUTT RD) 1ST ON RIGHT NAME of SUBDIVISION: Lot # B Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.789 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 4 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 YES, GRADING DONE AND SOIL PLACED OVER SEPTIC SYSTEM CAUSING FAILURE 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. Date: !lam Signature of Applicant or Agent~~ 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 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT , Side Authorization to Construct (Repair) F(11/18/2009 $300.00 Rear TOTAL FEES $300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60-charge 11/18/09 10:56 THIS IS NOT A PERMIT WLS #Hr~ CATAWBA COUNTY HEALTH DEPARTMENT Application 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 122 J /,-GPI S 2. Permit Requested By a 41l, TL Business Phone 2S4 2 $ I Y- Address d Home Phone 'Z 3 ~f'rr? 3. Property Owner l7.auzd L ~w t s Business Phone Address ome Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address / 11 eti ft Rd Directions to Property: 5. Property Size: Square Feet 7, 4kea_ Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home_ Dimension of Structure (1i o 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 as a for b y bedroom at the time of Basettment r e /noIance. 1hi Water pUsingt ythe need ize'li Fixtures in Basement: yesbno asc N~the future. in Family 't" Whirlpool ub yes/no 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 Ist 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes UO If so, describe: 8. Has any grading, removal, or addition of soil been done to this prope ~ Yes No If so, describe: a 9. Are there easem s/right-of-ways recorded on t is property? Yes / No 10. Is a public water supply available on or adjacent to the above property? Yes No Check type that is available: [ ] Community well [ ] Semi-public well [ County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual 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 © Signature of Owner or Agen _a~<.~~~f 11 Catawba County, North Carolina This map product eras prepared from the Catawba Countv, NC, Geographic Information System. N Caimrba Countv has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and reconmhends the independent verification of any data contained on this map product by the user. The County of Catawba, its entplovees, agents and personnel disclaim, and shall not be held liable for anv and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by anv person or entity. Legend Selected Parcel Number: 3755-04-71-4438 1 inch = 80 feet Prepared for: (Y) J J"i 6 r,-3 f 1 00 °p= 2.13A . U`5A N 56 U 2537 j 2`17 9' ~0. CO '443 z 010-) O 'N"ON THIS IS NOT A LEGAL DOCUMENT - Wednesday, November 18, 2009 10:37 AM 1 1 1 ~-w ~C 1 ~ ~z, `e A 1\ 1 / 1 r~ CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3755-04-71-4438 Name: LEWIS DAVID F Name2: LEWIS TAMMY W Address: 2744 HONEYCUTT RD Address2: City: CLAREMONT State: NC Zip: 28610-8038 Account: 41154800 Calc Acreage: 2.79 Tax Map: 1000 00080F LRK: 44730 Deed Book: 2050 Deed Page: 0490 Subdivision Name: Subdivision Block: Lots: B Plat Book: 26 Plat Page: 144 Building Number: 2744 Street Name: HONEYCUTT RD Site Zip: 28610 Township: CLINES Fire Code: OXFORD City Code: COUNTY State Road: 1702 Total Bldgs Value: $143,400 n~ Land Value: $22,500 ~1 Total Value: $165,900 Year Built: 1985 Year Remodeled: f~ Last Sale Date: 9/1/1997 Last Sale Amount: $130,000 Neighborhood: 67 Watershed: WS-IV Protected Area Watershed Split: NO p Voter Precinct: P27 E911 District: COUNTY (1~'J Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O,WP-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1):0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010101 Census Block 2010: 1016 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Wednesday, November 18, 2009 10:37 AM CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT r-~ Newton, NC 28658- (828)465-8399 Wednesday, November 18, 2009 A j8 1 SM www.catawbacountync.gov Plan Case: EHPR-11-09-2767 Invoice Number: INV-11-09-257354 Environmental Health Plan Review Invoice Date: 11/18/2009 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/18/2009 Cash -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 ilanieceint;h 791Q9-d- Jd-41?1-bU3a-ah38tfbc07RI'}.rpt 11/18/2009 10:56