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Home My WebLink AboutEHPR-12-09-3111 (2).TIF A THIS IS NOT A PERMIT Case # EHPR-12-09-31 l 1 CATAWBA COUNTY HEALTH DEPARTMENT cat`? Plan Review Application for Environmental Services Environmental Health Plan Review - OSWP 1842 5M REPAIR N,FPL CANT !ONVNER`1 ( ONTTRACTOR BEN ACORD BEN ACORD 2851 OLD SHELBY RD 2851 OLD,-SHELBY RD HICKORY NC 28601 'HICKORY NC 28601 8282679931 8282679931. NAME TO APPEAR ON PERMIT BEN ACORD Pin#: 278104512661 SITE ADDRESS: 2851 OLD SHELBY RD,.Hickory", NC , , DIRECTIONS: HWY 127 S/ RT MT GROVE CHURCH RD/ RT OLD SHELBY RD/ I ST TRIALER ON LF NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.449 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure Bedrooms 2 Basement: No Water I1sirfg Fixtures in Basement:N_o No. in Family Whirlpool Tub : C,al , Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet DiningArea 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: MIGHT ADD A BEDROOM LATER ON Has any grading, removal, or addition of soil-been done to~this property'? If so, describe Are there easements/right-of-ways recorded on this property? o 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 confor applicable setbacks. Date: Z m/o Signature of Applicant or Agent u -e~ An E vironmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 (FOR OFFICE USE ONLY) Zoning Approval: _Yes ✓ lo Zoning Approval UDO Zoning Form A Minimum Setbacks FEE ME DATE AMOUNT T _ v Front Side I ~ Authorization to Construct (Reuair)"`F~ 12/ I 1 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 12/14/09 14:01 V / THIS IS NOT A PERMIT WLS #li4P2" CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check New Well Permit Re lacement Well ❑ Well Abandonment E] I . Name to Appear on P it 2. Permit Requested By Business Phone Address< Home Phone 3. Property Owner ` Business Phone Address Home Phone y(o 7 S' 9 3 1 4. Name of Subdivision Lot # Section/Block/Phase Property Address S~2 /D S9 <-c r~ Directions to Property:. (-I 2 - C/ CV 5. Pr erty~ize: Square Feet 'cres Date tatted/Recorded 6. TYPE OF FACILITY: House Mobile Horne Dimension of Structure Bedrooms* *Any room-that v611 K Intended for Sleeping atthC tllll~ ~d 0111StrUCtloll oI )I_ IUIUI~ ~OnS1dClxlon ~Ilkmld bC not"d ~l, d 1~,~Iruon~ al d coulIt"d ~~r~'all appli~.nions. the ❑umh~i'`rl h,2~J.rooms kill h~ ~ur~limiLd by roonn< f~1rw ~d on h,,u,c hldn, q om t 111~IC~l~C Ill IhC fUtUIC. thL III!,: UI bUlldln(T pCl nllt ISSlLlnce Tlll~ in t\ pi- -V ent,tl'IC I1~C~I IVI >j_j1C111 Size h~~iru a Basement: yes no Water Using Fixtures in Basement: yes/io No. in Family Whirlpool Tub yes/0 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 / No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes J No If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes /INO 10. Is a public water supply available on or adjacent to the above property? s N 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 / ~1/'U Signature of Owner or Agent Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information Svstem. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information A contained on this map. Catawba Countv promotes and recommends the independent verification ofany 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 for any 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 any person or entity. Legend Selected Parcel Number: 2781-04-51-2661 1 inch = 60 feet Prepared for: L+824 R-20 ' R-20 9-7 r-- f ~ R-20 I I WI I~1 No I I 1 U. W I NI I: N I Monday, December 14, 2009 01:41 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2781-04-51-2661 Name:-, • ACORD BEN ANDREW ;Nw'i e2: ACORD SHIRLEY H Address: 2851 OLD SHELBY RD Address2: City: HICKORY State: NC Zip: 28602-8572 Account: 666000 Calc Acreage: 0.45 Tax Map: 177H 02002B LRK: 59567 Deed Book: 1317 Deed Page: 0985 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 2851 Street Name: OLD SHELBY RD Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: 1124 Total Bldgs Value: Land Value: $8,200 Total Value: $8,200 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 78 Watershed: Watershed Split: Voter Precinct: P24 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011101 Census Block 2010: 2058 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Monday, December 14, 2009 01:41 PM