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Home My WebLink AboutEHPR-11-09-2917 (2).TIF A C THIS IS NOT A PERMIT Case # EHPR-11-09-2917 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 ski Environmental Health Plan Review - OSWP EP_MALFUN _ i Ile G r APPLICANT OWNER CONTRACTOR KEITH HEFNER KEITH HEFNER 4210 NW 6TH ST 4210 NW 6TH ST HICKORY NC 28601-9091 HICKORY NC 28601-9091 (828)612-1740 (828)612-1740 NAME TO APPEAR ON PERMIT KEITH HEFNER Pin#: 370520717649 SITE ADDRESS: 4210 NW 6TH ST, Hickory, NC DIRECTIONS: HWY 127 N, LEFT ON 29TH AVE DR, PASS NEIL CLARK REC CENTER, TURNS INTO 6TH ST DR NW, RIGHT ON 39TH NW. WILL TURN INTO 6TH ST NW PROPERTY ON RIGHT ACROSS FROM 42ND AVE PL NW NAME of SUBDIVISION: EVERETTE AND ALMA BOWMAN LOTS Lot # 13 & PT 1: Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.73 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 60 X 52 Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 2 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 1st 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 Community Well Municipal X 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/-/- 3 69- 6-"2,ff Signature of Applicant or Agen 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 11/3 0/2009 $300.00 Rear TOTAL FEES 5300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/30/09 09:18 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit El Authorization to Construct El Septic Repair 0 Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit/ Z'u-11- 2. Perin it Requ sted By Business Phone 2- D Address ID 6 -1-4 '-A - Home Phone 3. Property Owner Business Phone - 7 U Address Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directions to Property: 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House pe- Mobile Home_ Dimension of Structure I U Bedrooms* 3 *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 }Mans as a bedroom at the rime o_Cbuildingpermit issuance.This may prevent the heed for system size increase in the future. Basement: ye /no Water Using Fixtures in Basement: (9/no No. in Family -2- Whirlpool Tub 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 I st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / 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? Yes / N 10. Is a public water supply available on or adjacent to the above property? (j;~/ 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 PROPERT RE I N AD ITIONAL CHARGE.** Date/ d_ Signature of Owner or Agent Gi%~4~~-~~-Yt Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling it formation contained on this map. Catawba County promotes and recommends the independent verification ofanv 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 fo any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise fron this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3705-20-71-7649 1 inch = 40 feet Prepared for: 787' 14 r t i ~ r, `r 12 751';8 ws r THIS IS NOT A LEGAL DOCUMENT Monday, November 30, 2009 08:59 AM CATAWBA ('OUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3705-20-71-7649 Name: HEFNER WILLIAM KEITH Name2: HEFNER ROBIN HUNT Address: 4210 6TH ST NW Address2: City: HICKORY State: NC Zip: 28601-9091 Account: 28429000 Calc Acreage: 0.73 Tax Map: 194H 01023 LRK: 61622 Deed Book: 2107 Deed Page: 0674 Subdivision Name: EVERETTE AND ALMA BOWMAN LOTS Subdivision Block: Lots: 13 & PT 12 & 14 Plat Book: 6 Plat Page: 157 Building Number: 4210 Street Name: 6TH ST NW Site Zip: 28601 Township: HICKORY Fire Code: HICKORY RURAL City Code: COUNTY State Road: 1322 Total Bldgs Value: $130,000 Land Value: $134,300 Total Value: $264,300 Year Built: 1951 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 2 Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P39 E911 District: HICKORY Zoning: R-3 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: HICKORY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: HICKORY Elementary School: JENKINS Middle School: NORTHVIEW High School: HICKORY School Split: NO P&Z Case Number: Census Tract 2010: 010500 Census Block 2010: 1030 Small Area Plan: Agricultural District: Printed: Monday, November 30, 2009 08:59 AM A C~ CATAWBA COUNTY, NC 100-A south West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Monday, November 30, 2009 j84'L sM www.catawbacountync.gov Plan Case: EHPR-11-09-2917 Invoice Number: INV-11-09-257586 Environmental Health Plan Review Invoice Date: 11/30/2009 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 1113012009 Check 6608 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 planicc iPt;c 98fl1`~o-hbUl-1-i?.1-aW'6-I "i~c-t~-Ik.iri; rill 11/30/2009 09:17